超高龄急性心肌梗死患者住院病死率及相关因素分析

The in-hospital mortality and its determinants for very elderly patients with acute myocardial infarction

目的 探讨超高龄急性心肌梗死（AMI）患者的院内病死率及相关因素.方法 采用回顾性队列研究方法,对自2002年1月至2010年2月期间住院年龄≥80岁超高龄AMI患者进行分析.结果 499例患者住院期间死亡97例,病死率为19.4％,其中ST段抬高急性心肌梗死（STEAMI）297例,死亡69例,病死率23.2％,非ST段抬高心肌梗死202例,死亡28例,病死率13.9％,两者差异有统计学意义（P=0.009）.死亡组与存活组临床资料单因素比较显示：死亡组感染、消化道出血、高血压病史、完全性房室传导阻滞、心脏破裂、心功能KillipⅢ、Ⅳ级、肾功能不全及STEAMI的比例显著高于存活组（P值均＜0.05）；而行急诊经皮冠状动脉介入治疗（PCI）的比例显著低于存活组（P＜0.05）.多因素logistic回归分析显示：心功能Killip分级、完全性房室传导阻滞、肾功能不全、急诊支架植入及心肌梗死类型为高龄AMI患者院内死亡的独立预测因素.结论 心功能Killip分级、完全性房室传导阻滞、肾功能不全、是否行急诊植入支架及MI类型为超高龄AMI患者院内死亡的独立预测因素,对超高龄AMI患者在掌握适应证的前提下行PCI可提高其住院存活率.

Objective To explore the in-hospital mortality and its determinants for very eldly （80 ＋ years of age） patients with acute myocardial infarction （AMI）.Methods A retrospective cohort method was used.The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1,2002 and February 22,2010.Results Ninety-seven out of 499 patients died during hospitalization period,with total in-hospital mortality of 19.4%.Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades,complete A-V block,renal dysfunction,stent implant,and the type of AMI.Conclusions The independent determinants for mortality of elderly AMI patients are as following,cardiac Killip grade,complete A-V block,renal dysfunction,stent implant,and the type of MAI.Urgent PCI is safe and effective for some very elderly with AMI,which could improve their survival rate within hospitalization period.