高龄急性心肌梗死患者的临床特点

Clinical features of acute myocardial infarction in very old patients

目的探讨高龄和非高龄急性心肌梗死患者的临床表现和治疗措施的差异。方法将临床确诊为急性心肌梗死年龄≥75岁的46例患者（高龄组）与〈75岁的308例患者（非高龄组）进行对照研究，回顾性分析其临床症状、危险因素和采用的治疗措施。结果与非高龄组比较，高龄组患者以呼吸困难、疲乏等心功能不全为首发症状者多见（39．1％vs16．6％，P〈0．01），女性（56．5％VS29．2％，P〈0．05）及非ST段抬高心肌梗死（45．7％w28．2％，P〈0．01）多见。高龄组合并高血压、糖尿病（60．9％W47．1％，34．8％Ⅷ15．6％，P〈0．05）比例高，而血脂异常、吸烟比例低于非高龄组（32．6％VS52．3％，34．8％VS63．6％，P〈0．05）。高龄组从出现症状到入院时间更长（P〈0．05），接受冠状动脉造影及再灌注治疗者少于非高龄组（78．2％VS95．8％，71．8％VS94．8％，P〈0．05。高龄组肾功能恶化者更多见（6．5％VS0．3％，P〈0．05）。结论高龄急性心肌梗死患者的不典型临床症状多见，而且接受再灌注治疗者的比例低。

Objective To compare the differences in clinical manifestation and treatment measures in very old patients and elderly patients with acute myocardial infarction （AMI）. Methods Clinical data of 354 identified AMI patients who were admited in our hospital from June 2008 to June 2012 were subjected in this study. They were divided into 2 groups, that is, very old group age ranging from 75 to 91years, mean （79.5 ± 3.4）years, n = 46 and elderly group age ranging from 36 to 74years, mean （61.8 ＋ 8.4）years, n = 308. Their clinical symptoms, risk factors and management strategies were retrospectively analyzed, and compared between the 2 groups. Results There were more patients having dyspnea, fatigue and other heart failure symptoms as the first symptoms at AMI onset in very old group than in elderly group （39.1% vs 16.6%, P 〈 0.01）. More women （56.5% vs 29.2%, P 〈 0.05） and more non-ST-segment elevation myocardial infarction （45.7% vs 28.2%, P 〈 0.01） was found in very old group （P 〈 0.01）. In very old group, there were more patients with hypertension （60.9% vs 47.1%, P 〈 0.05） and with diabetes mellitus （34.8% vs 15.6%, P〈 0.05）, but less patients with dyslipidemia （32.6% vs 52.3%, P〈 0.05） and cigarette smoking （34.8% vs 63.6%, P 〈 0.05） when compared with those from elderly group. Time from symptom onset to hospital admission was significantly longer in very old group （P 〈 0.05）. Both coronary angiography （78.2% vs 95.8%, P 〈 0.05） and reperfusion procedures （71.8% vs 94.8%, P〈 0.05） were less applied to the very old patients （P 〈 0.05）. Worsening renal function was more frequently in very old patients（6.5% vs 0.3%, P 〈 0.05）. Conclusion There are more atypical clinical presentation and less reperfusion therapy in very old patients with acute myocardial infarction.