急性心肌梗死合并心原性休克死亡危险因素分析

Predictors of short term mortality in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock

目的 探讨ST段抬高的急性心肌梗死合并心原性休克（cardiogenic shock,CS）患者的近期预后和影响病死率的独立危险因素,为CS患者的死亡风险评估提供参考.方法 采用国际多中心CREATE研究的中国ST段抬高急性心肌梗死患者517例资料,平均年龄（68.5±10.3）岁,男性患者占57.6%.用单变量和多变量logistic回归分析合并CS患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 517例CS患者30 d的病死率为62.3%（322例）.将全部变量进行多因素logistic回归分析显示年龄（OR=1.46,95%GI：1.18～1.81）、前壁梗死（OR=2.01,95%CI：1.29～3.11）、入院基线血糖＞7.8 mmol/L（OR=2.17,95%CI：1.26～3.73）、血钠＜130 mmoL/L（OR=2.21,95%CI：1.21～4.04）、左心室射血分数（LVEF）＜40%或重度左心功能障碍（LVD）（OR=3.78,95%CI：2.28～6.27）、未紧急血运重建（OR=3.53,95%CI：1.20～10.41）和使用利尿剂（OR=1.90,95%CI：1.21～2.97）是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线（ROC）分析两个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.81（95%CI：0.77～0.86）和0.80（95%CI：0.75～0.84）.结论 STEMI并发CS的患者30 d病死率超过60%,年龄等基线因素和未紧急血运重建等治疗因素是影响30 d病死率的独立危险因素.

Objective To explore the indepedent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction（STEMI）complicated by cardiogenic shock （CS）. Methods We analyzed data from Chinese patients with ST-segment elevation myocardial infarction （STEMI）and cardiogenic shock enrolled in the CREATE trial. Predictors of 30-day mortality were identified by univariate and multivariate logistic regression analysis using baseline and procedural variables. Results The overall 30-day mortality of STEMI complicated by CS among the 517 patients[（68.5±10.3）years and 57. 6% male]was 62.3%. Logistic regression analysis showed that the independent risk factors of death included age（OR = 1.46,95% CI： 1.18 - 1.81）, anterior infarction（OR = 2.01,95% CI 1.29 - 3.11）,admission glucose level 〉 7. 8 mmol/L（OR = 2. 17,95% CI： 1.26 - 3.73）, serum sodium concentration 〈130 mmol/L（OR =2. 21,95% CI：1. 21 -4. 04）, left ventricular ejection fraction（LVEF）〈40% or sever left ventricular dysfunction（LVD）（OR = 3.78,95% CI： 2. 28 - 6. 27）, no emergency revascularization （OR = 3.53, 95% CI： 1.20 - 10. 41）and diuretics use（OR = 1.90,95% CI： 1.21 - 2. 97）. Analysis using baseline clinical variables showed that the first five risk factors mentioned above were also the baseline risk factors fro death. The receiver operating characteristic curve for predicting the death of the two models was 0.81（95%CI：0. 77 -0.86）and 0. 80（95%CI：0. 75 -0.84）, respectively. Conclusion The 30-day mortality of patients with STEMI complicated by CS was over 60%. Age, anterior infarction, admission glucose level 〉7.8 mmol/L, serum sodium concentration 〈 130 mmol/L, left ventricular ejection fraction （LVEF）〈40% and no emergency revascularization were independent risk factors associated with 30-day mortality.