中国非ST段抬高型心肌梗死患者住院期间死亡的危险因素分析

Risk Factor Analysis for In-hospital Mortality in Patients With Non-ST Segment Elevation Myocardial Infarction in China

目的:探讨中国非ST段抬高型心肌梗死患者(NSTEMI)住院期间死亡的危险因素。方法:纳入2013-01至2014-09期间参加中国急性心肌梗死(CAMI)注册登记研究的NSTEMI患者5 816例。352例患者在住院期间死亡,为住院期死亡组,余住院期间生存的5 464例患者为住院期生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等资料,以住院期间死亡为主要结局指标构建多因素Logistic回归模型,探讨NSTEMI患者住院期间死亡独立危险因素。结果:6.05%(352/5816)的NSTEMI患者在住院期间死亡,两组患者基线资料存在显著差异。多因素Logistic回归分析结果提示,年龄[每增加1岁,比值比(OR)=1.027;95%可信区间(CI):1.014~1.041;P<0.01)、体重指数(每增加1kg/m^2,OR=0.943;95%CI:0.900~0.988;P<0.01)、收缩压(每增加1 mmH g,OR=0.983;95%CI:0.978~0.988;P<0.01)、Killip心功能分级(每增加1级,OR=1.565;95%CI:1.370~1.786;P<0.01)、心跳骤停(OR=3.118;95%CI:1.339~7.262;P<0.01)、ST段压低(OR=1.571;95%CI:1.169~2.110;P<0.01)、新发完全性左束支传导阻滞(OR=4.579;95%CI:1.876~11.177;P<0.01)、血肌酐(每增加1μmol/L,OR=1.004;95%CI:1.002~1.005;P<0.01)、白细胞计数(每增加1×109/L,OR=1.100;95%CI:1.071~1.130;P<0.01)、从不吸烟(OR=2.080;95%CI:1.460~2.962;P<0.01)、既往心肌梗死病史(OR=1.913;95%CI:1.298~2.820;P<0.01)、经皮冠状动脉介入治疗(PCI)史(OR=0.322;95%CI:0.142~0.729;P<0.01)是患者住院期间死亡的独立危险因素。结论:本研究发现12个因素是NSTEMI患者住院期间死亡的独立危险因素,有助于临床医生早期识别高危患者并选择最佳诊疗策略。

Objective： To explore the risk factors for in-hospital mortality in patients with non-ST segment elevation myocardial infarction （NSTEMI） in China. Methods： The information of 5816 NSTEM1 patients from 2013-01 to 2014-09 by China Acute Myocardial Infarction （CAMI） registry were extracted. Our research included in 2 groups： In-hospital death group, n=352 and In-hospital survival group, n=5464. The baseline condition, laboratory examination, treatment and the in-hospital outcomes were collected; the independent risk factors for in-hospital mortality were studied by multivariable Logistic regression analysis. Results： 6.05% （352/5816） patients died during hospitalization. The baseline conditions were different between 2 groups. Multivariable Logistic regression analysis indicated that age, BMI, systolic blood pressure, Killip classification, heart arrest, ST-segment depression in ECG, new onset of Complete left bundle branch block, serum creatinine, white blood cells, Count non-smoker, previous history of MI and PCI were the independent risk factors for in-hospital mortality in NSTEMI patients. Conclusion： The above 12 variables were the independent risk factors for in-hospital mortality in NSTEMI patients which should be helpful for identifying the high risk patients at the early stage in clinical practice.