急性冠脉综合征患者血清钙与心血管预后的关系

doi:10.3969/j.issn.1006-7795.2023.01.023

摘要/Abstract

摘要： 目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清钙与心血管预后的相关性。方法选取2019年6月至2019年12月首都医科大学附属北京天坛医院心血管内科收治住院的ACS患者721例,所有患者均行冠状动脉造影。收集患者的临床资料,采集血标本测定血清钙等生化指标。所有患者随访1年,记录终点事件的发生情况。分析血清钙与ACS患者心血管预后的关系。结果 721例ACS患者,平均年龄(62.23±10.00)岁,男性527例(73.1%),平均随访(10.92±2.96)个月,110例(15.26%)发生终点事件,其中心血管死亡1例、再次心肌梗死3例、不稳定性心绞痛103例、缺血性卒中3例。所有患者根据血清钙四分位数分为Q₁组(<2.20 mmol/L)、Q₂组(2.20～2.26 mmol/L)、Q₃组(2.27～2.31 mmol/L)、Q₄组(≥2.32 mmol/L)。Q₁组急性心肌梗死患者比例高于Q₃组和Q₄组(P<0.05),Q₁组GRACE评分高于Q₂、Q₃组和Q₄组(P<0.05),Q₁组心血管事件的发生率高于Q₄组(P<0.05)。Kaplan-Meier分析显示,ACS患者的血清钙浓度越高,无心血管事件概率越低,组间差异有统计学意义(log-rank χ²=9.787,P＝0.020)。Cox比例风险模型校正潜在混杂因素后,发现血钙低浓度(HR=0.096,95% CI:0.014~0.646,P=0.016)与心血管不良预后相关,血钙浓度低的ACS患者,不良心血管预后的风险增大。结论血清钙浓度降低是ACS患者不良心血管预后的独立危险因素,对识别高危ACS患者具有重要参考价值。

关键词: 急性冠脉综合征, 血清钙, 全球急性冠状动脉事件注册, 预后

Abstract: Objective To investigate the relationship between serum calcium and cardiovascular prognosis in patients with acute coronary syndrome (ACS). Method A total of 721 ACS patients hospitalized in the Department of Cardiovascular Medicine, Beijing Tiantan Hospital,Capital Medical University from June 2019 to December 2019 were selected, and all patients underwent coronary angiography. The clinical data of the patients were collected and blood samples were drawn to determine biochemical indexes such as serum calcium. All patients were followed up for 1 year. And the occurrence of endpoint events was recorded. The relationship between serum calcium and cardiovascular prognosis in ACS patients was analyzed. Results Among the 721 ACS patients, the mean age was (62.23±10.00) years, 527 (73.1%) were males, and the mean follow-up was (10.92±2.96) months. Among them, 110 patients (15.26%) had an end point event, including 1 case of cardiovascular death, 3 cases of recurrent myocardial infarction, 103 cases of unstable angina, and 3 cases of ischemic stroke. All patients were divided into group Q₁ (<2.20 mmol/L), group Q₂ (2.20－2.26 mmol/L), group Q₃ (2.27－2.31 mmol/L) and group Q₄ (≥2.32 mmol/L).The proportion of patients with acute myocardial infarction in Q1 group was higher than that in Q₃ and Q₄ groups (P <0.05), the GRACE score in Q₁group was higher than that in Q₂, Q₃and Q₄ groups (P<0.05), and the incidence of cardiovascular events in Q₁ group was higher than that in Q₄ group (P<0.05). Kaplan-meier analysis showed that patients with the lowest serum calcium level had a worse cardiovascular prognosis (log-rank χ²=9.787, P=0.020). In addition, after adjusting for potential confounders in the multivariate Cox proportional risk model, lower serum calcium level (HR=0.096, 95%CI:0.014－0.646, P=0.016) was independently associated with cardiovascular outcomes. Conclusion Low serum calcium level is an independent risk factor for adverse cardiovascular outcome in patients with ACS. And the decrease of serum calcium level has an important reference value for identifying high-risk ACS patients.

Key words: acute coronary syndrome, serum calcium, Global Registry of Acute Coronary Events, prognosis

中图分类号:

R541.4

王荣荣, 田俊萍. 急性冠脉综合征患者血清钙与心血管预后的关系[J]. 首都医科大学学报, 2023, 44(1): 154-160.

Wang Rongrong, Tian Junping. Correlation between serum calcium and cardiovascular outcome in patients with acute coronary syndrome[J]. Journal of Capital Medical University, 2023, 44(1): 154-160.

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