不同治疗方式对老年急性ST段抬高心肌梗死的临床疗效分析

The study of the effects of different treatments for elderly patients with acute ST-elevation myocardial infarction.

目的评价老年急性ST段抬高心肌梗死不同再灌注治疗的临床治疗现状及疗效。方法回顾性分析2001年3月至2003年6月国内12个心脏中心随机入组的236例年龄≥60岁的急性ST段抬高心肌梗死（STEMI）患者住院期间的临床资料，比较再灌注治疗和非再灌注治疗组的临床疗效及转归。结果（1）有接近32％的患者未接受任何形式的再灌注治疗；（2）接受再灌注治疗组患者于发病12h内就诊比例明显高于未接受再灌注治疗组（67．8％对32．2％）；（3）糖尿病病史是未能接受再灌注治疗的预测因素（OR值为3．216，95％可信区间为2．127～6．432）；（4）再灌注治疗组住院期间再发心绞痛、充血性心力衰竭者明显低于未接受再灌注治疗组（P〈0．05）；（5）接受再灌注治疗组患者的病死率明显降低（5．6％对21．7％）。结论再灌注治疗可以降低年龄≥60岁的急性STEAMI患者的住院病死率，减少住院期间不良心血管事件的发生，且不增加该组患者住院期间的并发症。

Objective To evaluate the clinical effect of different reperfusion therapies for elderly （ 〉 60 yrs）acute coronary syndrome（ACS） with ST elevation myocardial infarction （STEMI）. Methods Retrospective analysis of clinical data was done in 236 STEMI patients aged more than 60 years who were enrolled randomly from 12 hospitals. Reperfusion strategies were assessed. Results （ 1 ） Nearly 32% patients received no reperfusion. （ 2 ） The ratio of patients who arrived at hospital in 12 hours from the episode of chest pain was higher in the reperfusion group than that in no-reperfusion（67. 8% vs 32. 2% ） patients. （ 3 ） Multivariable logistic regression analysis showed that diabetes was the predictor of no reperfusion （ OR was 3. 216,and 95% CI was 2. 127 - 6. 432 ）. （4） The occurrence of in-hospital recurrent angina and congestive heart failure was lower in patients who received reperfusion than that in patients who received no reperfusion（ P 〈 0. 05 ）. （5） The mortality in patients who received reperfusion therapies reduced obviously compared with that in patients who received no reperfusion therapy （5.6% vs 21.7% ）. Condusion Reperfusion therapy not only reduces in-hospital mortality for elderly patient with STEMI ACS but also reduces in-hospital adverse cardiac events without increasing in-hospital complications.