急性心肌梗死并发致死性心律失常的危险因素及预后分析

Analysis of the risk factors and prognosis in patients with acute myocardial infarction complicated with lethal arrhythmia

目的:探讨急性心肌梗死(AMI)并发致死性心律失常30 d死亡的危险因素。方法:回顾性分析我院4年期间收治的384例ST段抬高型心肌梗死(STEMI)并发致死性心律失常患者的临床资料及30 d病死率,通过多因素Logistic回归分析,探讨影响AMI并发致死性心律失常30 d病死率的独立预测因素。结果:384例患者中,30 d病死率为53.13%。单因素分析显示,女性、年龄>60岁、Killip分级Ⅱ级以上、侧壁心肌梗死、前壁心肌梗死、未接受溶栓治疗及经皮冠状动脉介入治疗(PCI),未应用阿司匹林/氯吡格雷、未应用静脉硝酸盐制剂,未接受降脂治疗和未应用抗心律失常药是增加AMI并发致死性心律失常患者30 d病死率的相关因素(均P<0.05);多因素Logistic回归分析显示,高龄、前壁心肌梗死、Killip分级IV级和未接受降脂治疗是影响AMI并发致死性心律失常患者30 d病死率的独立预测因素(均P<0.05)。结论:高龄、前壁心肌梗死、Killip分级IV级和未用降脂治疗是影响AMI并发致死性心律失常患者30 d病死率的独立预测因素。临床上应重视患者病情的评估,积极进行临床干预,强化降脂治疗以改善患者的预后。

Objective：To explore the risk factors of 30-day mortality in patients with acute myocardial infarction （AMI）complicated with lethal arrhythmias.Methods：Clinical data and the 30-day mortality of 384 patients with ST elevation myocardial infarction （STEMI） complicated with fatal arrhythmia in our hospital were retrospectively analyzed.The independent risk factors that influencing 30-day mortality in patients with AMI complicated with lethal arrhythmias were analyzed by multivariate logistic regression analysis.Results：The 30-day mortality rate of the 384 patients was 53.13%.Single factor analysis showed that female,older than 60 years old,more than Killip grade Ⅱ,lateral wall and anterior wall myocardial infarction,without usage of thrombolytic therapy,without percutaneous coronary intervention,without administration of aspirin / clopidogrel,application of intravenous nitrates,lipid-lowering therapy and application of antiarrhythmic drugs were the related factors of 30-day mortality in patients with AMI complicated with lethal arrhythmias （all P 〈 0.05）.Multivariate logistic regression analysis showed that the elderly,anterior wall myocardial infarction,Killip grade Ⅳ and lack of lipid-lowering therapy were the risk factors that influencing 30-day mortality in patients with AMI complicated with lethal arrhythmias （P 〈 0.05）.Conclusions：Elderly,anterior wall myocardial infarction,Killip grade Ⅳ and without lipid-lowering therapy are the independent predictive factors that influencing 30-day mortality in patients with AMI complicated with lethal arrhythmias.Patients＇ condition should be paid attention and intervened actively.Intensive lipid-lowering therapy can improve the prognosis.