老年急性心肌梗死患者死亡及危险因素的回顾性分析

Mortality and risk factors for elderly patients with acute myocardial infarction： a retrospective analysis

目的：探讨不同年龄段老年急性心肌梗死（AMI）患者的死亡情况及危险因素。方法回顾性地分析2006年12月至2012年1月入院的883例60～89岁的AMI患者（按年龄分为两组，60～74岁为老年组共473例，75～89岁为高龄组共410例）的一般情况、既往病史及家族史、临床检查及诊断、并发症、治疗及生存情况。结果老年组死亡率明显低于高龄组（5.9%vs 14.6%，P＝0.000），经皮冠状动脉介入（PCI）治疗率明显高于高龄组（92.6%vs 69.8%，P＝0.000）。两组患者死亡均与尿素氮、血糖、白细胞、脑钠肽（BNP）水平高，并发窦性停搏、心室颤动、心房颤动、心源性休克、Killip 3-4级，使用主动脉内球囊反搏（IABP），未手术呈正相关；与药物（包括血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、β受体阻滞剂、他汀类药物）使用率呈负相关。尿素水平高、并发窦性停搏与心源性休克、未手术为两组患者死亡的独立危险因素。结论积极PCI治疗可改善老年AMI患者预后，需重视其尿素氮水平及窦性停搏、心源性休克等并发症。

Objective To investigate the in-hospital mortality and risk factors among the elderly acute myocardial infarction （AMI） patients at different ages. Methods The clinical data of 883 elderly AMI patients hospitalized in our department from December 2006 to January 2012 were collected and retrospectively analyzed. They were assigned into 2 groups based on their age：old group （60 to 74 years old, n=473）, and very old group （75 to 89 years old, n=410）. Their general condition, medical history and family history, admission examination, clinical diagnosis, complications, treatment and in-hospital mortality were compared and analyzed. Results The old group had significantly lower in-hospital mortality than very old group （5.9% vs 14.6%, P=0.000）. There were significantly more patients undergoing percutaneous coronary intervention （PCI） in old group than in very old group（92.6% vs 69.8%, P=0.000）. The in-hospital mortality was positively correlated with the increased levels of blood urea nitrogen, blood glucose, white blood cells and brain natriuretic peptide （BNP）. Complications with arrhythmia （sinus arrest, ventricular and atrial fibrillation）, cardiogenic shock and Killip3-4 group, placement of intra-aortic balloon counterpulsation （IABP）, and no surgical treatment were also positively correlated with in-hospital mortality. And it was negatively correlated with receiving drugs [angiotensin converting enzyme inhibitors （ACEI）/angiotensinⅡreceptor blockers （ARB）,β-blockers and statins]. High level of blood urea nitrogen, complications with sinus arrest and cardiogenic shock, and no surgical treatment were independent risk factors for in-hospital mortality in both groups. Conclusion Application of PCI improves prognosis of the elderly patients with AMI. More attention should be paid to blood urea nitrogen and complications such as sinus arrest and cardiogenic shock.