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急性心肌梗死发生的昼夜节律及其对12个月内预后的影响

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摘要:

目的 探究中国人急性心肌梗死(AMI)发生的昼夜节律及其与患者12个月之内预后的
关系。方法 回顾性分析2015年1月1日至2016年10月25日就诊于吉林大学中日联谊医院诊断为AMI且
其心肌梗死(心梗)发生时间明确的患者467例。按其心梗发生时间分为早晨组(定义为06:00~11:59
期间发生的AMI)(162例)和其他时间组(305例),记录其临床基本资料、在院期间发生的死亡
及心力衰竭(心衰)及其出院后随访期间发生的全因死亡、再发急性冠脉综合征(ACS)、因心衰
再次住院及主要不良心脏事件(MACE)的发生,以及复查造影结果。结果 将24 h按每2 h划分,在
06:00~07:59中出现AMI发生的1个高峰(13.27%);按每6 h划分,在06:00~11:59出现AMI发生的1个高峰
(34.69%)。Kaplan-Meier生存曲线示早晨组患者出院后12个月之内有更高的MACE累计风险(76.3%
vs. 50.3%,P=0.041),更高的因心衰再次住院的累计风险(53.5% vs. 39.3%,P=0.032)。多因素COX
回归分析显示,AMI发生在06:00~11:59期间是AMI患者出院后12个月内因心衰再次住院的独立危险因素
(HR=6.458,95%CI:2.015~20.697,P=0.002)。随访期间复查造影结果示早晨组患者有更高的非靶血
管血运重建(NON-TVR)发生率(29.3% vs. 11.1%,P=0.019)。结论 06:00~11:59期间发生AMI患者出
院12个月之内具有较高的MACE的累计风险、因心衰再次住院的累计风险、和更高的NON-TVR发生率,
故对这部分患者应予以高度的重视,加强随访,及时处理出现的不良事件。

Abstract:

Objective To discuss the circadian variation of acute myocardial infarction (AMI) in Chinese
population and relationship between it and patients’ prognosis within 12 months. Methods AMI patients (n=467)
with definite diagnosis and AMI attack time were chosen from Department of Cardiology in China-Japan Union
Hospital of Jilin University from Jan. 1, 2015 to Oct. 25, 2016 and their data was retrospectively analyzed. All patients
were divided into morning group (AMI attacked from 06:00 am to 11:59 am, n=162) and other time group (n=305). The
clinical basic materials, incidence of death or heart failure during hospitalization period, and all-cause mortality, reonset
acute coronary syndrome (ACS), re-hospitalization due to heart failure and major adverse cardiovascular events
(MACE) during follow-up period after discharged were recorded, and results of coronary angiography were reexamined.
Results One peak of AMI attack was found from 06:00 am to 07:59 am (13.27%) based on dividing 24 h into 2 h.
One peak of AMI attack was found from 06:00 am to 11:59 am (34.69%) based on dividing 24 h into 6 h. The results
of Kaplan-Meier survival curve analysis showed that the aggregation risks of MACE (76.3% vs. 50.3%, P=0.041) and
re-hospitalization due to heart failure (53.5% vs. 39.3%, P=0.032) were higher in morning group within 12 months
after discharged. The results of multi-factor COX regression analysis showed that AMI attacked from 06:00 am to
11:59 am was an independent risk factor of AMI (HR=6.458, 95%CI: 2.015~20.697, P=0.002) within 12 months after
discharged. The results of reexamination of coronary angiography showed that the incidence rate of non-target vessel
revascularization (NON-TVR) was higher in morning group (29.3% vs. 11.1%, P=0.019) during follow-up period.
Conclusion The patients with AMI attack from 06:00 am to 11:59 am had higher aggregation rates of MACE and rehospitalization
due to heart failure and higher incidence rate of NON-TVR within 12 months after discharged. So more
attention should be paid to them, follow-up should be enhanced and MACE should be disposed in time.

基金项目:

国家自然科学基金(81570360)

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