再发心肌梗死的危险因素及对短期预后的影响

Risk factors and in-hospital prognosis of recurrent acute myocardial infarction

目的探讨再发急性心肌梗死（AMI）的危险因素及对短期预后的影响。方法连续入选2006年1月至2010年12）1在北京大学人民医院住院治疗的AMI患者1447例。根据病史分为初发AMI组（n=1268）和再发AMI组（n=179）。记录患者性别、年龄、心血管相关危险因素、人院时心功能、心肌梗死类型、冠状动脉造影结果、住院期间死亡率、入院24h内的血脂、空腹血糖、血清肌酐等，并用logisticN归模型探寻再发AMI的危险因素。结果与初发AMI患者相比，再发AMI患者年龄较大，合并糖尿病的比例高。同时患者人院时心功能差，冠状动脉病变程度重。Logistic回归分析结果显示，年龄（OR1．03，95％CI：1．01～1．04，P〈0．01）、糖尿病（OR2．10，95％CI：1．51～2．91，P〈0．01）、吸烟（0R1．76，95％CI：1．20～2．57，P〈0．01）、血清肌酐水平（OR1．003，95％CI：1．001～1．004，P〈0．01）是再发AMI的独立危险因素。与初发AMI患者相比，再发AMI患者住院期间全因死亡率及心源性死亡率有升高趋势，但差异无统计学意义。结论年龄、糖尿病、吸烟、血清肌酐水平是再发AMI的独立危险因素。再发AMI患者住院期间短期死亡率并不明显增加。

Objective To investigate the risk factors and in-hospital outcomes of recurrent acute myocardial infarction （AMI）. Methods A total of 1447 consecutive AMI patients admitted to our hospital from January 2006 to December 2010 were recruited. Their clinical background, angiographic findings, heart function, infarction types, serum indices within 24 h after hospitalization and in-hospital prognosis were retrospectively compared between patients with first AMI （n = 1268） and those with recurrent AMI （n = 179）. Logistic regression analysis was used to study the risk factors of recurrent AM1. Results Patients with a recurrent AMI were older and had a higher prevalence of diabetes mellitus （DM） than those with first AMI. In addition, they also had worse heart function at admission and more severe coronary lesions. Logistic regression analysis indicated that the independent risk factors of recurrent AMI included age （OR, 1.03; 95% CI ： 1.01-1.04, P〈 0.01）, DM （OR, 2.10; 95% CI： 1.51-2.91, P〈 0.01）, smoking （OR, 1.76; 95% CI： 1.20-2.57, P 〈 0.01）, and serum creatinine （OR, 1.003; 95% CI ： 1.001-1.004, P 〈 0.01）. Recurrent AMI had an increasing trend in in-hospital all-cause death as well as cardiac-related death compared with a first AMI, though with no significant difference between the 2 groups. Conclusion Age, DM, smoking and serum creatinine are independent risk factors for the recurrence of AMI. Recurrent AMI has no effect on in-hospital death.