並列タイトル等外科治療を施行されたStanford A型急性大動脈解離患者における退院時心拍数と長期予後の関連について
一般注記Background: Resting heart rate (HR) at discharge is an important predictor of mortality after acute myocardial infarction. However, in patients with Stanford type A acute aortic dissections (TA-AADs), the relationship between HR and long-term outcomes is unclear. Therefore, this relationship was investigated in the present study. Methods and Results: Surgically treated consecutive patients with TA-AAD (n=721) were retrospectively categorized according to HR quartiles, recorded within 24h before discharge (<70, 70–77, 78–83, and ≥84beats/min). The study endpoints included aortic aneurysm-related deaths, sudden deaths, aortic surgeries, and hospitalizations for recurrence of acute aortic dissections. The mean (±SD) patient age was 65.8±13.0 years. During a median observation period of 5.8 years (interquartile range 3.9–8.5 years), 17.2% of patients (n=124) experienced late aortic events. Late aortic surgery was performed in 14.0% of patients. After adjusting for potential confounders, including β-blocker use, HR at discharge remained an independent predictor of long-term aortic outcomes. Patients with discharge HR ≥84beats/min had a higher risk (hazard ratio 1.86; 95% confidence interval 1.06–3.25; P=0.029) of long-term aortic events than those with HR <70beats/min; the cumulative survival rates were similar among the groups (log-rank, P=0.905). Conclusions: In surgically treated patients with TA-AAD, HR at discharge independently predicted long-term aortic outcomes. Consequently, HR in patients with TA-AAD should be optimized before discharge, particularly if the HR is ≥84beats/min.
Circulation Journal. 2021, 85(12), 2192-2200.
新大院博(医)第995号
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