老年急性心肌梗死患者临床特点以及住院死亡的危险因素

Clinical characteristics and risk factors of in-hospital death in elderly patients with acute myocardial infarction

目的 分析老年急性心肌梗死（AMI）患者的临床特点以及住院死亡的危险因素。方法 回顾性入选自2008年1月~2014年1月在北京军区总医院住院治疗的AMI患者476例,其中男性338例,女性138例,年龄61~85岁。依据预后分为：存活组（377例）和死亡组（99例）。比较两组入院后24 h内肌钙蛋白T（c Tn T）、肌酸激酶同工酶（CK-MB）、B型脑钠肽（BNP）总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和肌酐水平,计算肾小球滤过率并分析两组患者的心功能Killip分级及左室射血分数（LVEF）。Logistic回归分析老年AMI患者住院死亡的危险因素。结果与存活组比较,死亡组的既往病史比例、吸烟比例、室速或室颤比例、CK-MB、c Tn T、HDL-C、BNP以及心功能KillipⅢ级和Ⅳ级比例升高,肾小球滤过率、LVEF下降,差异均有统计学意义（P均〈0.05）。年龄（OR=1.074,95%CI：1.038~1.121）、糖尿病（OR=1.332,95%CI：1.528~8.034）、冠心病（陈旧性心肌梗死）（OR=5.627,95%CI：1.807~16.840）、肾小球滤过率（OR=1.442,95%CI：1.021~2.107）,心功能Killip分级（OR=3.432,95%CI：1.074~82.455）、室性心律失常（室速或室颤）（OR=3.835,95%CI：1.317~9.812）、c Tn T（OR=1.010,95%CI：1.002~1.011）、LVEF（OR=0.860,95%CI：0.818~1.923）是住院死亡的独立危险因素（P均〈0.01）。结论 高龄、合并糖尿病和陈旧性心肌梗死、肾小球滤过率降低、c Tn T升高、Killip分级高、LVEF降低、室性心律失常是老年急性AMI患者住院死亡的独立危险因素。

Objective To analyze the clinical characteristics and risk factors of in-hospital death in elderly patients with acute myocardial infarction （AMI）. Methods AMI patients （n=476, male 338, female 138 and aged from 61 to 85） were chosen from Jan. 2008 to Jan. 2014, and then divided into survival group （n=377） and death group （n=99） according to the prognosis. The levels of cardiac troponin T （cTnT）, creatine kinase MB （CK-MB）, B-type brain natriuretic peptide （BNP）, total cholesterol （TC）, low-density lipoprotein-cholesterol （LDL-C）, high-density lipoprotein-cholesterol （HDL-C） and creatinine （Cr） were detected, and glomerular filtration rate （GFR） was calculated. The risk factors of in-hospital death were analyzed by using Logistic regression analysis. Results The percentages of cases with past medical history, smoking, ventricular tachycardia or ventricular fibrillation, higher levels of CK-MB, cTnT, HDL-C and BNP, and percentages of cases with cardiac Killip gradeⅢand Killip gradeⅣincreased, and GFR and LVEF decreased in death group compared with survival group （all P〈0.05）. Age （OR=1.074, 95%CI：1.038~1.121）, diabetes （OR=1.332, 95%CI：1.528~8.034）, coronary heart disease （old myocardial infarction, OR=5.627, 95%CI：1.807~16.840）, GFR （OR=1.442, 95%CI：1.021~2.107）, cardiac Killip grading （OR=3.432, 95%CI：1.074~82.455）, ventricular arrhythmia （ventricular tachycardia or ventricular fibrillation, OR=3.835, 95%CI：1.317~9.812）, cTnT （OR=1.010, 95%CI：1.002~1.011） and LVEF （OR=0.860, 95%CI：0.818~1.923） were independent risk factors of in-hospital death （all P〈0.01）. Conclusion Advanced age, complicating diabetes and old myocardial infarction, decreased GFR, increased cTnT, higher cardiac Killip grade, lower LVEF and ventricular arrhythmia all are independent risk factors of in-hospital death in elderly patients with AMI.