摘要
目的:探讨80岁以上急性心肌梗死(AMI)患者院内生存情况及危险因素。方法:连续纳入2012年1月至2017年12月心血管内科收治的80岁以上的138例AMI患者,分析该人群的一般状况、病史、实验室检查、诊断、治疗、院内生存情况及相关危险因素。结果:患者平均年龄为(84.97±3.52)岁;非ST段抬高型心肌梗死(NSTEMI)占73.19%,ST段抬高型心肌梗死(STEMI)占26.81%;53例(38.41%)行经皮冠状动脉介入术(PCI),其余接受药物保守治疗,NSTEMI患者选择药物保守治疗的比例显著高于STEMI患者(P<0.001)。33例住院期间死亡,院内病死率呈逐年下降趋势。根据患者院内存活情况,将患者分为院内死亡组(n=33)和院内存活组(n=105),院内死亡组STEMI比例、Killip分级≥3级比例、中性粒细胞数、N末端脑钠肽前体(NT-proBNP)水平显著高于院内存活组,而PCI治疗比例则显著低于院内存活组(P均<0.05)。多因素logistic回归分析发现,Killip分级≥3级(OR=3.038,P=0.009)和STEMI(OR=6.854,P=0.002)是80岁以上AMI患者院内死亡的独立危险因素,而PCI治疗是其保护因素(OR=0.060,P<0.001)。结论:80岁以上AMI患者NSTEMI占多数,合并症多,PCI治疗率低,院内病死率高,预后较差,AMI严重程度与心功能差是患者院内死亡的重要危险因素,而PCI治疗是其保护因素。
Objective:To investigate the in-hospital mortalities and risk factors of patients aged over 80 years with acute myocardial infarction(AMI). Methods:Clinical data of patients aged over 80 with AMI admitted to the department of cardiology from January 2012 to December 2017 were collected. We performed the analysis of general condition,medical history,laboratory tests,diagnosis,treatment modality and in-hospital mortality in these patients. Results:A total of 138 patients were enrolled,with an average age of(84.97±3.52)years;ST-segment myocardial infarction (STEMI)accounted for 26.81% while Non-ST-segment myocardial infarction (NSTEMI)accounted for 73.19%.Fifty-three patients (38.41%)received percutaneous coronary intervention (PCI)and the others received conservative treatment.The proportion of conservative treatment in NSTEMI group was significantly higher than that in STEMI group(P<0.001).Thirty-three patients died during hospitalization,and the in-hospital mortality rate decreased year by year.According to the outcome of patients,they were divided into in-hospital death group and survival group.The rate of Killip≥3,rate of STEMI,levels of neutrophils and NT-proBNP in the death group were significantly higher,while the rate of PCI was lower than those in survival group(all P<0.05).Multivariate logistic regression analysis showed that Killip≥3(OR=3.038,P=0.009)and STEMI(OR=6.854,P=0.002)are the independent riskfactors of in-hospital death while PCI is the protective factor(OR=0.060,P<0.001). Conclusions:The majority of AMI patients aged over 80 years have many complications with NSTEMI being more prevalent.PCI treatment rate is low and the prognosis is relatively poor with high in-hospital mortality. Poor cardiac function is an important risk factor for in-hospital mortality and PCI is the protective factor.
作者
赵健
贺治青
张艳达
梁春
ZHAO Jian;HE Zhiqing;ZHANG Yanda;LIANG Chun(Changzheng Hospital,Second Military Medical University,Shanghai 200003,China)
出处
《国际心血管病杂志》
2019年第1期52-55,共4页
International Journal of Cardiovascular Disease
基金
上海市医学领军人才计划(LJRC2015-21)
