急性心肌梗死合并致死性心律失常的近期死亡危险因素分析

Risk factors of short term mortality in patients with acute ST-elevation myocardial infarction complicated with fatal arrhythmia

目的探讨ST段抬高的急性心肌梗死（STEMI）合并致死性心律失常患者的30d预后和影响病死率的独立危险因素，为这类患者的死亡风险评估提供参考。方法回顾性分析国际多中心CREATE研究的中国STEMI合并心律失常患者资料，用单变量和多变量logistic回归分析这部分患者的基线特征因素和治疗因素与30d病死率的相关性。结果合并致死性心律失常718例患者平均年龄（66．1±11．9）岁，男性占62．4％，30d的病死率为52．9％（380例）。将全部变量进行多因素logistic回归分析显示年龄（OR=1．82，95％CI：1．449～2．285）、前壁梗死（OR：4．419，95％CI：2．645—7．384）、心率〉60次／min（OR：3．32，95％叫：1．898—5．808）、Killip1V级（OR：3．686，95％CI：1．686～8．060）、糖化血红蛋白〈5．6％（OR=2．564，95％CI：1．199～5．484）、未用血管紧张素转化酶抑制剂（ACEI）（OR=1．827，95％cj：1．099～3．038）、未用降脂治疗（OR=2．034，95％CI：1．196—3．458）是30d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2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0．830（95％CI：0．796—0．865）和0．866（95％CI：0．835～0．896）。结论STEMI并发致死性心律失常患者30d病死率超过50％，年龄、前壁心肌梗死、心率≥60次／min、Killip分级Ⅳ级和未用ACEI、未用降脂治疗等是影响30d病死率的独立危险因素。

Objective To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction （STEMI）complicated with fatal arrhythmia. Methods We analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial. Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables. Results The overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [ （66. 1± 11.9） years and 62. 4% male] was 52. 9%. Logistic regression analysis showed that age （ OR = 1.82,95% CI： 1. 449 - 2. 285 ）, anterior infarction （ OR = 4.419,95 % CI：2. 645 - 7. 384）, heart rate 〉 60 bpm （ OR = 3.32, 95 % CI： 1. 898 - 5. 808）, killip class 1V （ OR = 3. 686,95% CI： 1. 684 - 8.06 ）, admission hemoglobin A1 e 〈 5.6% （ OR = 2. 564, 95%CI：1.199-5.484）, no use of ACEI （OR=1.827, 95%CI：1.099-3.038） and no use of lipid-lowing drugs （ OR = 2. 034, 95% CI： 1. 196 - 3. 458 ） were independent risk factors for short term mortality after STEMI. The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0. 830 （ 95% CI： O. 796 - 0. 865 ） and 0. 866 （ 95% CI： 0. 835 - 0. 896 ）, respectively. Conclusion The 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high. Age, anterior infarction, heart rate 〉 60 bpm, killip class IV, admission hemoglobin Alc level 〈 5.6% , no use of ACEI and no use of lipid-lowing drugs are independent risk factors for 30-day mortality inthese patients.