背景:有有限的证据表明,在急性失代偿性心力衰竭患者就诊后早期使用硝酸盐可以改善临床结果。我们的目的是在一项大型回顾性队列研究中确定早期硝酸盐暴露是否与提高生存率相关。
结果:我们检查了安大略省急诊科就诊的11078名急性失代偿性心力衰竭患者,加拿大,在2004年至2007年期间,在有效心脏治疗的增强反馈和急诊心力衰竭死亡率风险等级研究中。在倾向匹配分析中,我们检查了急性急诊科患者服用硝酸盐对7日,30日和365日死亡的影响.在倾向匹配分析中,我们发现在急诊科接受硝酸盐治疗的患者和非硝酸盐对照组之间的生存率没有差异.7天内死亡率的危险比为0.76(95%CI;0.51,1.12),30天内0.97(95%CI;0.77,1.21),和0.91(95%CI;0.82,1.02)超过1年的随访。在延长的随访中,硝酸盐和非硝酸盐对照组之间的生存率或住院时间没有显着差异。在存在胸痛的亚组中,硝酸盐也没有显着影响,肌钙蛋白升高,长期使用硝酸盐,和已知的冠状动脉疾病。
结论:在急性失代偿性心力衰竭中,在急诊科急性使用硝酸盐与短期或近期生存率的改善无关.当治疗的主要目标是降低死亡率时,我们的研究不支持广泛使用硝酸盐。
BACKGROUND: There is limited evidence that the use of nitrates in acute decompensated heart failure early after presentation to a hospital can improve clinical outcomes. We aimed to determine whether early nitrate exposure is associated with improved survival in a large retrospective cohort study.
RESULTS: We examined 11 078 acute decompensated heart failure patients who presented to emergency departments in Ontario, Canada, between 2004 and 2007, in the Enhanced Feedback For Effective Cardiac Treatment and the Emergency Heart failure Mortality Risk Grade studies. In propensity-matched analyses, we examined the effect of nitrate administration in the acute emergency department setting for its impact on death at 7, 30, and 365 days. In propensity-matched analyses, we found no difference in survival between those who received nitrates in the emergency department and the non-nitrate comparator group. Hazard ratios for mortality were 0.76 (95% CI; 0.51, 1.12) over 7 days, 0.97 (95% CI; 0.77, 1.21) over 30 days, and 0.91 (95% CI; 0.82, 1.02) over 1 year of follow-up. There was no significant difference in survival or hospital length of stay between nitrate and non-nitrate controls in extended follow-up. There was also no significant effect of nitrates in subgroups stratified by presence of chest pain, troponin elevation, chronic nitrate use, and known coronary artery disease.
CONCLUSIONS: In acute decompensated heart failure, use of nitrates acutely in the emergency department setting was not associated with improvement in short-term or near-term survival. Our study does not support generalized use of nitrates when the primary goal of therapy is to reduce mortality.