初发急性ST段抬高心肌梗死患者预后的影响因素分析

Aanalysis of Prognosis Influence Factors in Patients with Initial Onset ST-segment Elevation Myocardial Infarction

目的:研究初发急性ST段抬高心肌梗死患者预后的影响因素。方法:选取我院2010年收治的发病24小时内初发急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)258例,收集患者病史、化验检查、心脏彩超、冠状动脉造影结果等住院资料,并随访主要心血管事件,通过相关分析求出对预后有统计学意义的因素,再分别通过Logistic回归及Cox回归分析急性心肌梗死患者近期及远期预后的影响因素。结果:AMI患者住院死亡率6.2%(16/258例),影响住院死亡率因素为PCI治疗(r=-0.253,P=0.000,OR=0.318,95%CI:0.101-0.997)、血糖(Glu)(r=0.24,P=0.01,OR=1.136,95%CI:1.020-1.265)两个因素;平均随访7.6±3.8月,总终点事件10.3%(25/242例),心源性死亡患者6例(2.5%);经Cox回归分析与远期死亡相关的因素是高敏C反应蛋白(Hs CRP)(r=0.182,P=0.008,OR=1.223,95%CI:1.065-1.403)。结论:急性心肌梗死预后受多种因素影响,影响住院死亡率的因素为PCI治疗及血糖,影响远期死亡的因素是Hs CRP。

Objective： To Study the influence factors for prognosis of initial onset ST elevated myocardial infarction patients.Methods： We selected 258 cases of ST-segment elevation myocardial infarction（STEMI） patients in our hospital in 2010 as research subjects, whose symptoms were onset in 24 hour, colleted patients informations of medical histories, laboratory examinations, UCG and CAG, and followed up major cardiovascular events. To analyse the statistically significant influence factors for prognosis by correlation analysis, then through Logistic regression and Cox regression analyse the influence factors for short and long-term prognosis of AMI patients. Results： The resident death rate of AMI patients was 6.2%（16/258）, and the influence factors with resident death of AMI hospitalized patients were primary PCI（r=-0.253, P=0.000, OR=0.318, 95%CI： 0.101-0.997） and fasting blood glucose levels（r=0.24, P=0.01,OR=1.136, 95%CI： 1.020-1.265）; Followed up on average 7.6±3.8 months, the total major cardiovascular events were 10.3%（25/242）,the percentage of cardiac death was 2.5%（6/242）; The influence factor with long-term death rate of AMI patients through Cox regression was Hs CRP concentration（r=0.182, P=0.008, OR=1.223, 95%CI：1.065-1.403）. Conclusion： There were several reasons for short and long-term prognosis of AMI patients. The influence factors with resident death of AMI hospitalized patients were primary PCI and fasting blood glucose levels, and the influence factor with long-term death rate of AMI patients was Hs CRP.