【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。更多还原

【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.更多还原