中国急性心肌梗死患者住院期间死亡的危险因素分析

Risk Factors Analysis for In-hospital Mortality in Patients With Acute Myocardial Infarction in China

目的:探讨当代中国急性心肌梗死(AMI)患者住院期间死亡的危险因素。方法:纳入2013年01月至2014年09月中国急性心肌梗死(CAMI)注册登记研究的AMI患者23417例[其中5795例非ST段抬高型心肌梗死(NSTEMI)患者和17622例ST段抬高型心肌梗死(STEMI)患者]。1504例患者在住院期间死亡,为死亡组,余住院期间生存的21913例患者为生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等临床资料,以住院期间死亡为主要终点构建多因素Logistic回归模型,探讨AMI患者住院期间死亡的独立危险因素。结果:6.42%(1504/23417)的AMI患者在住院期间死亡。与生存组比较,死亡组患者年龄更大,女性患者更多,体重指数更低,合并糖尿病、高血压的比例更高,Killip心功能分级更高,并发症更多,并且更易出现心脏骤停(P均<0.05)。多因素Logistic回归分析结果提示,年龄、性别、体重指数、收缩压、心率、血肌酐水平、白细胞计数、血清钾浓度、血清钠浓度、STEMI、前壁心肌梗死、心脏骤停、Killip心功能分级、高血压、高脂血症及吸烟史是预测患者住院期间死亡的独立危险因素。结论:本研究发现16个当代中国AMI患者住院期间死亡的独立危险因素,有助于临床医师早期识别高危患者并选择最佳诊疗策略。

Objectives:To explore the risk factors for in-hospital mortality among contemporary patients with acute myocardial infarction(AMI)in China.Methods:The information of 23417 AMI patients(including 5795 NSTEMI and 17622 STEMI)from 2013-01 to 2014-09,derived from China Acute Myocardial Infarction(CAMI)registry,was extracted.Our research included 2 groups:In-hospital death group(n=1504)and In-hospital survival group(n=21913).The baseline condition,laboratory examination,treatment and the inhospital outcomes were compared;the independent risk factors for in-hospital mortality were evaluated by multivariable logistic regression analysis.Results:6.42%(1504/23417)patients died during hospitalization.The baseline conditions were different between 2 groups.Multivariable logistic regression analysis indicated that age,gender,body mass index,systolic blood pressure,heart rate,creatinine level,white blood cell count,serum potassium,serum sodium,ST-segment elevation on ECG,anterior wall involvement,cardiac arrest,Killip classification,medical history of hypertension,medical history of hyperlipidemia and smoking status were the independent risk factors for in-hospital mortality in AMI patients.Conclusions:The above mentioned 16 variables are the independent risk factors for in-hospital mortality among contemporary AMI patients.Special care should be applied to AMI patients with above risk factors and these patients at risk should be treated accordingly to reduce the incidence of in-hospital death in daily clinical practice.