29例急性心肌梗死院内死亡原因分析

Analysis of 29 patients in-hospital mortality with acute myocardial infarction

目的探讨导致急性心肌梗死院内死亡的相关危险因素。方法总结437例急性心肌梗死患者资料,分为院内死亡组(29例)及存活组(408例),对比临床资料,分析年龄、入院时心功能Killip分级、入院时心率、及非心脏合并症等情况,并分析29例院内死亡病例的死亡直接原因。结果死亡组年龄>70岁,入院时心功能Killip分级在>Ⅱ级,入院时心率>100次/分,前壁心肌梗死,新发的阵发性心房颤动/心房扑动较对照组有显著性差异(P<0.05)。多因素Logistic回归分析表明,年龄>70岁(P=0.0104,OR=4.68,95%CI1.286～15.792)、入院时心功能Killip>Ⅱ级(P=0.0072,OR=6.93,95%CI1.647～19.314)、前壁心肌梗死(P=0.0247,OR=3.81,95%CI 1.165～11.389)、新发的阵发性心房颤动/心房扑动(P=0.0169,OR=5.26,95%CI1.401～16.129)是急性心肌梗死院内死亡的独立危险因素。在29例死亡病例中,心源性休克导致死亡的病例是16例(55%),心脏破裂导致死亡的病例是11例(38%)。结论年龄>70岁、入院时心功能Killip>Ⅱ级、前壁心肌梗死、新发的阵发性心房颤动/心房扑动是急性心肌梗死院内死亡的独立危险因素。

Objective To investigate the outcome and risk factors of in-hospital mortality in patients with acute myocardial infaction.Methods 437 patients with acute myocardial infaction were divided into two groups including in-hospital death group and survival group.The age, heart rate, Killip class, non-cardiac comorbidity, direct cause of death, were analyzed.Results Compared with suivivors, in-hospital mortality was associated with such factors：including older than 70 years of age （76% vs.45%,P0.05）, Killip class2 （69% vs.11%,P0.001）, heart rate 100 bpm （31% vs.10%, P0.05）, anterior myocardial infaction（45% vs.26%, P0.05）, and with new onset of atrial fibrillation/atrial flutter （34% vs.8%, P0.05）.After logistic multivariable regression analysis, older than 70 years of age （P=0.0104, OR=4.68, 95%CI 1.286～15.792）and Killip class2 （P=0.0072,OR= 6.93,95%CI 1.647～19.314）, anterior myocardial infaction（P=0.0247, OR=3.81, 95%CI 1.165～11.389）, and new onset of atrial fibrillation/atrial flutter （P=0.0169, OR=5.26, 95%CI 1.401～16.129） were independent precdictors of in-hospital mortality.Cardiaogenic shock was the direct cause of death in 16 cases（55%）, cardiac rupture was the direct cause in 11patients （38%）.Conclusions Older than 70 years of age, Killip class2, anterior myocardial infaction,and new onset of atrial fibrillation/atrial flutter were independent risk factors of in-hospital mortality.Cardiaogenic shock are the major reasons of in-hospital mortality.