80岁以上急性ST段抬高性心肌梗死患者临床特点及治疗策略选择的影响因素分析

Clinical features and impact factors of treatment strategy in very elderly patients with acute ST-segment elevation myocardial infarction

目的:探讨80岁以上急性ST段抬高性心肌梗死(STEMI)患者的临床特点,分析影响治疗策略选择的主要因素。方法:回顾性分析2013年1月至2014年12月,在北京安贞医院确诊为 STEMI的80岁以上患者64例,比较手术治疗组,含冠状动脉造影术、经皮冠状动脉介入治疗(PCI)和冠状动脉旁路移植术(CABG)(37例)与保守治疗组(27例)的住院期间的临床资料,如年龄、性别、LVEF、既往病史(如高血压、糖尿病及肾功能不全等)、心肌梗死部位及并发症等。采用Logistic多因素回归模型分析影响治疗策略选择的因素。结果:保守治疗组患者年龄[(83.4±3.1)vs.(81.9±1.8)岁,P =0. 028]、住院天数[12 (4,14)7( 5,10) d,P = 0. 012]显著高于手术治疗组,而住院费用则显著更低[15 942(9 094,22 341)vs.51 281(18 448,67 005)元,P<0. 001]。保守治疗组陈旧性心肌梗死(63.0%vs.37.8%,P=0.047)、肾功能不全(37.0%vs.8. 1%,P=0.004)、室壁瘤[22.2%vs.2.7%,P=0.039]以及合并两种以上并发症[40.7%vs10. 8%,P=0. 005)患者所占比例明显高于手术治疗组。单因素Logistic 回归显示:高龄(P=0. 023)、陈旧性心肌梗死(P=0. 050)、肾功能不全(P=0. 009)、室壁瘤(P=0.036)以及合并两种以上并发症(P=0. 008)是影响治疗策略选择的主要因素;多因素Logistic回归模型显示高龄(HR= 1.418,95 % CI: 1.054 ~ 1. 907,P = 0.021)、合并两种以上并发症(HR=5. 959,95 % CI:1.243-28. 564,P=0. 026)是患者治疗策略选择的影响因素。结论:高龄和合并两种以上并发症是患者选择保守治疗的主要影响因素。

Objective: To investigate the clinical features and impact factors of treatment strategy in very elderly patients(^80 years) with acute ST-segment elevation myocardial infarction (STEMI). Methods: We retrospectively investigated 64 patients aged 80 years or older with STEMI who hospitalized in Beijing An Zhen Hospital between January 2013 to December 2014. Patients were divided into two groups: these who recie- ved conservative treatment ( CST, n = 27 ) and these underwent operative treatment ( OPT, n = 37 ). The OPT group included coronary angiography ( CA),percutaneous coronary intervention ( PCI) and coronary artery bypass graft ( CABG). The Baseline characteristics, risk factors, clinical treatment and complications were ana- lyzed. Results: Compared with the OPT group,CST group had significantly older age (83. 4± 3. 1) 2;5.( 81. 9± 1. 8)(P = 0. 028), longer hospitalization days[ 12 (4,14) vs. 7(5,10)d,P=0. 012], but lower hospitalization costs[ 15 942(9 094,22 341) vs. 51 281(18 448,67 005)yuan,P<0. 001]. CST group had significantly more old myocardial infarction( OMI)(63. 0% vs. 37. 8%,P = 0. 047),renal dysfunction( RD)( 37. 0% vs. 8. 1%,P= 0.004), ventricular aneurysm ( 22. 2% vs. 2. 7%, P = 0. 039 ) and incidence of two kinds of complication (40. 7% vs. 10. 8% 9 P = 0. 005).Univariate logistic regression analysis shown that the age(P=0. 023),OMI(P =0. 050) nRD(P=0. 009) Nventricular aneurysm( P = 0. 036) and incidence of two kinds of complication( P = 0. 008 ) were the main impact factors of treatment strategy. After adjustment of multivariable logistic regression a- nalysis, the age(HR= 1. 418,95%CI:1. 054-1. 907,P=0. 021)and incidence of two kinds of complication(HR=5. 959,95%CI:1. 243-28. 564,P=0. 026) were independently the main impact factors of treatment strategy. Conclusions: For these very elderly patients(≥80 years) with STEMI,older age or incidence of two kinds of complication is the main impact factors of conservative treatment strategy .