衰弱对老年急性心肌梗死患者的影响

Effect of frailty on outcome in elderly acute myocardial infarction patients

目的探讨老年急性心肌梗死(AMI)患者衰弱的危险因素及其对结局的影响。方法选择2014年9月~2017年7月首都医科大学附属北京朝阳医院住院的老年AMI患者203例,根据FRAIL衰弱量表分为衰弱组98例(FRAIL衰弱量表≥3分)和非衰弱组(FRAIL衰弱量表<3分)105例。衰弱组接受冠状动脉造影48例,非衰弱组接受冠状动脉造影76例。分析衰弱的相关危险因素,并记录死亡、再次AMI、脑卒中、大出血和恶性心律失常等主要不良心脑血管事件(MACCE)。结果非衰弱组冠状动脉造影检查比例明显高于衰弱组(72.4%vs 49.0%,P<0.01)。多因素logistic回归分析显示,年龄、N末端B型钠尿肽前体、Charlson共病指数和跌倒史是衰弱的独立危险因素(P<0.05,P<0.01)。衰弱组住院期间MACCE发生率明显高于非衰弱组(27.6%vs 10.5%,P=0.002)。调整年龄、N末端B型钠尿肽前体、Charlson共病指数和跌倒史等混杂因素后,多因素logistic回归分析显示,衰弱是住院期间MACCE发生的独立危险因素(OR=2.420,95%CI:1.193~4.942,P=0.001)。结论老年AMI患者衰弱发生率高,年龄、N末端B型钠尿肽前体、Charlson共病指数、跌倒史是衰弱的独立危险因素,衰弱会增加老年AMI患者住院期间MACCE。

Objective To study the risk factors for frailty and its effect on the outcome in elderly acute myocardial infarction(AMI)patients.Methods Two hundred and three elderly AMI patients admitted to our hospital from September 2014 to July 2017 were divided into frailty group or frailty scale score≥3 group(n=98)and frailty-free group or frailty scale score<3 group(n=105).The risk factors for frailty in elderly AMI patients were analyzed.The incidence of MACE(death,recurrent AMI,stroke,massive hemorrhage and malignant arrhythmia)in elderly AMI patients was recorded.Results The rate of coronary angiography was significantly higher in frailty-free group than in frailty group(72.4%vs 49.0%,P<0.01).Multivariate logistic regression analysis showed that age,NT-proBNP,Charlson comorbidity and falling history were the independent risk factors for frailty in elderly AMI patients(P<0.05,P<0.01).The incidence of MACE was significantly higher in frailty group than in frailty-free group(27.6%vs 10.5%,P=0.002).Multivariate logistic regression analysis showed that frailty was an independent risk factor for the incidence of MACCE in elderly AMI patients during their hospital stay time(OR=2.420,95%CI:1.193-4.942,P=0.001).Conclusion Age,NT-proBNP,Charlson comorbidity and falling history are the independent risk factors for frailty which increases the incidence of MACCE in elderly AMI patients during their hospital stay time.