急性心肌梗死患者患病构成比及住院死亡率变化趋势

Trends of in-hospital mortality and constituent ratio of patients with acute myocardial infarction

目的分析2004至2014年间于北京安贞医院住院的急性心肌梗死(AMI)患者中,非ST段抬高型心肌梗死(NSTEMI)和ST段抬高型心肌梗死(STEMI)的患病比例及其住院死亡率的变化。方法回顾性分析2004年1月1日至2014年12月31日于北京安贞医院住院治疗且主要出院诊断为"急性心肌梗死"的所有患者,收集其基线资料、AMI类型、住院日、血运重建及院内死亡信息。应用χ2趋势检验分析2004至2014年STEMI和NSTEMI构成比及其住院死亡率的变化趋势。结果共入选AMI患者23864例,其中STEMI患者5539例,NSTEMI患者18325例。与STEMI患者比较,NSTEMI患者年龄更大、男性比例更低,伴有高血压病、高脂血症、糖尿病史者更多,而有吸烟史者的比例更少(P均<0.001)。NSTEMI患者更多为再次梗死[12.6%(695/5539)比7.4%(1354/18325),P<0.001],且更多有冠状动脉旁路移植术史[2.7%(152/5539)比0.7%(124/18325),P<0.001]。NSTEMI占总AMI的患病比例在11年内呈明显上升趋势,由2004年的15.8%(107/802)上升至2014年的35.7%(1273/3583)(趋势χ2检验P<0.001)。观察期内NSTEMI患者院内死亡共102例(1.84%),明显低于STEMI患者(2.74%,502例,P<0.001)。二者11年内死亡率均呈明显降低趋势(趋势χ2检验,P均<0.001)。在校正其他危险因素后,NSTEMI仍是住院死亡率的独立预测因素(OR=0.50,95%CI0.40~0.63,P<0.001)。结论在心肌梗死患者中,NSTEMI的患者比例在2004至2014年呈逐年上升趋势。NSTEMI患者住院期间死亡率低于STEMI患者,二者死亡率均呈明显下降趋势。

Objective To analyze the trends on constituent ratio of non-ST-segment-elevation (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI) and related in-hospital mortality in acute myocardial infarction (AMI) patients hospitalized in Beijing Anzhen Hospital from 2004 to 2014. Methods This is a single-center, retrospective study. We reviewed all patients hospitalized for AMI in Beijing Anzhen Hospital from January 1 2004 to December 31 2014, and collected all related information including hospitalization stay, the type of AMI, revascularization and in-hospital mortality. We analyzed the trends of constituent ratio of NSTEMI and STEMI, and their in-hospital mortalities during the 11 years. Results Data from a total of 23 864 patients with AMI, including 5 539 STEMI and 18 325 NSTEMI, were analyzed. Compared with STEMI patients, NSTEMI patients were older, less likely to be male (P<0.001), had higher prevalence of hypertension, hyperlipidemia, diabetes (P<0.001), and lower prevalence of smoking (P<0.001). Additionally, patients with NSTEMI were more likely to have prior history of MI (12.6%(695/5 539) vs. 7.4%(1 354/18 325), P<0.001) and coronary artery bypass graft surgery (2.7%(152/5 539) vs. 0.7%(124/18 325), P<0.001). The constituent ratio of NSTEMI was significantly increased during the observation period, rising from 15.8%(107/802) in 2004 to 35.7%(1 273/3 583) in 2014 (P value for trend <0.001). The in-hospital mortality of NSTEMI patients was significantly lower compared with those with STEMI (1.84%(102 cases) vs. 2.74%(502 cases), P<0.001). The mortality of both STEMI and NSTEMI were significantly decreased during the 11 years (both P value for χ2 trend test <0.001). After adjusting for other risk factors, NSTEMI was independently associated with lower in-hospital mortality (OR=0.50, 95%CI 0.40-0.63, P<0.001). Conclusions In patients with AMI, the constituent ratio of NSTEMI versus STEMI is increased during the 11 years. The in-hospital mortality is decreased for both STEMI and NSTEMI patients in the past 11 years, and the in-hospital mortality rate of NSTEMI patients is lower than STEMI patients in this patient cohort during the observation period.