老年人急性心肌梗死近期转归分析

An analysis of the short-term outcome of elderly patients with acute myocardial infarction

目的探讨老年急性心肌梗死（ＡＭＩ）患者近期转归的影响因素，为降低病死率提供理论依据。方法连续住院的３０５例首次ＡＭＩ老年患者，男１４６例，女１５９例，对比分析其临床基础情况、梗死表现、治疗及临床经过、住院病死率及死亡原因，并对影响转归的变量进行多元回归分析。结果老年女性并存高血压和糖尿病的百分率较男性高（分别为５６％对２９％，３３％对１８％），男性吸烟者较女性多（４０％对２％），差异均有显著性（均为Ｐ＜０．０１）。老年女性的心力衰竭、休克、机械并发症和住院病死率均高于男性（均为Ｐ＜０．０５）。然而，多元回归分析显示，性别并不是住院死亡的独立危险因子（ＯＲ，０．７３；９５％ＣＩ，０．２５～２．２３），而心功能Ｋｉｌｉｐ分级（ＯＲ，６．８２；９５％ＣＩ，２．５０～１８．９１）、机械并发症（ＯＲ，５３．１８；９５％ＣＩ，１１．５６～４０１．３０）、肌酸激酶（ＣＰＫ）峰值（ＯＲ，１．６９；９５％ＣＩ，１．１８～２．４７）等可能有重要预后价值。结论老年ＡＭＩ患者死亡危险性增加与心脏本身的危险因子有关，而性别无重要影响。

Objective To evaluate the factors,influencing the shortterm outcome of elderly patients with acute myocardial infarction (AMI). Methods The clinical history and evolution of 305 consecutive patients including 146 men and 159 women, ≥60 years of age, admitted with first AMI were compared. The inhospital mortality and the causes of death were analyzed. Multiple logistic regression analysis was performed among the variables correlated with adverse outcomes. Results Women had a higher prevalence of hypertension (56% versus 29%, P<001) and diabetes (33% versus 18%, P<001). Smokers were more in men (40% versus 2%, P<001). Women showed higher incidence of congestive heart failure, shock, mechanical complications and inhospital mortality (respectively, P<005). However, multiple logistic regression analysis excluded sex as an independent predictor of inhospital mortality (OR,073;95%CI,025223). Whereas. Killip class (OR,682;95%CI,2501891), mechanical complications (OR,5318;95%CI,115640130)and peak levels of CPK (OR,169;95%CI, 118247) were probably of important prognostic value. Conclusions The increase of mortality risk in the elderly after a first AMI seems to be related to the cardiac risk factor itself rather than to sex.