急性心肌梗死合并肾功能不全患者的预后因素分析

Prognostic factors for patients with acute myocardial infarction and renal dysfunction

目的:探讨影响急性心肌梗死(AMI)合并肾功能不全(RD)患者的预后因素.方法:本研究纳入2014年1月1日至2019年4月30日期间,在北京安贞医院住院并诊断为AMI合并中重度RD的患者,记录基线特征、并发症及实验室辅助检查结果,随访患者终点事件,进行单因素和多因素COX分析明确影响患者预后的因素.结果:共随访727例AMI合并RD患者,平均年龄(65.3±11.2)岁,男性513例.随访期间,发生主要不良心脏事件(MACE)330例,其中全因死亡254例,再发心肌梗死30例,再次血运重建60例.冠状动脉介入(PCI)治疗患者的MACE和全因死亡显著低于未接受PCI治疗者(P<0.05).两组再发心肌梗死差异无统计学意义(4.6%vs.3.7%,P>0.05),PCI治疗者再次血运重建率高于未接受PCI治疗者(11.8%vs.5.0%,P<0.05).多因素分析显示男性和PCI术与AMI合并RD患者MACE减少有关,射血分数下降的心力衰竭(HFrEF)、心源性休克、合并感染可能与MACE增加有关.结论:AMI合并中重度RD患者预后差,合并心力衰竭、心源性休克、感染可能是MACE增加的危险因素,而接受PCI、男性可能与其长期预后的改善有关.

Objective:To explore the prognostic factors affecting patients with acute myocardial infarction(AMI)and renal dysfunction(RD).Methods:This study included patients hospitalized in Beijing Anzhen Hospital and diagnosed with AMI with concurrent moderate to severe RD from January 1,2014 to April 30,2019.Baseline characteristics,complications,laboratory and auxiliary-examination result,and treatment method were recorded.Major adverse cardiovascular events(MACE)and secondary endpoints in these patients were followed up,and univariate and multivariate Cox regression analyses were performed to determine the possible effects of various factors on patients’prognoses.Results:A total of 727 patients with AMI and RD were included and followed up for 12-71 months,513 of whom were male,with a mean age of(65.3±11.2)years.A total of 330 MACE cases occurred during follow-up,including 254 cases of all-cause death,30 cases of recurrent myocardial infarction,and 60 cases of revascularization.In percutaneous coronary intervention(PCI)-treated patients,MACE and all-cause mortality were significantly lower than in those not treated with PCI(P<0.05).Multivariate analysis showed that male sex and PCI might be related to the MACE reduction in the patients with AMI and RD;meanwhile,heart failure with reduced ejection fraction,cardiogenic shock,infection,and hemofiltration might be related to the MACE increase.Conclusions:The patients with AMI and RD had poor prognoses.In these patients,heart failure,cardiogenic shock,and infection might be independent risk factors related to the increase in MACE,while receiving PCI and male sex might be associated with improved longterm prognosis.