高龄(≥80岁)急性心肌梗死患者的临床特征及预后影响因素分析

Analysis of Clinical Characteristics and Prognostic Factors of Elderly Patients(≥80 Years Old)with Acute Myocardial Infarction Who Underwent Invasive Treatment

目的分析高龄(≥80岁)急性心肌梗死(AMI)患者的临床特征及预后影响因素。方法连续性纳入2014年8月至2017年8月260例接受介入治疗的高龄(≥80岁)AMI患者,其中121例为非ST段抬高心肌梗死(NSTEMI)患者,139例为ST段抬高心肌梗死(STEMI)患者。采用单因素及多因素Logistic回归分析法分析高龄AMI患者预后影响因素。结果本组260例高龄AMI患者平均年龄83(81,84)岁,其中NSTEMI患者年龄低于STEMI患者,且差异有统计学意义(P=0.03)。NSTEMI患者121例(46.5%),STEMI患者139例(53.5%)。左主干病变患者37例(14.2%);Killip心功能≥2级187例(71.9%);3支病变支数151例(58.1%)。合并高血压、糖尿病的AMI患者比例较高,分别为72.3%和42.7%;无论NSTEMI患者还是STEMI患者,合并高脂血症的AMI患者比例均超过90%。NSTEMI患者入院时收缩压及左心室射血分数高于STEMI患者,陈旧性心肌梗死病史、高血压史、支架术后患者比例,服用他汀、β受体阻滞剂的患者比例也均高于STEMI患者,且差异均有统计学意义(P<0.05)。NSTEMI患者没有行冠脉介入术的患者比例高于STEMI患者,而植入主动脉内球囊反搏(IABP)的患者比例低于STEMI患者,且差异均有统计学意义(P<0.05)。NSTEMI患者再住院率高于STEMI患者(P<0.01)。多因素Logistic回归分析结果显示,左心室射血分数高是高龄AMI患者预后的保护性因素(OR=0.96,95%CI=0.92-1.01,P=0.04);服用β受体阻滞剂是NSTEMI患者预后的保护性因素(OR=0.32,95%CI=0.11-0.98,P=0.04);外周动脉疾病是高龄STEMI患者预后的危险因素(OR=5.93,95%CI=1.50-23.40,P<0.05)。结论接受介入治疗的高龄(≥80岁)AMI患者一般具有合并症多、病变支数多、心功能差、病死率高的特点,NSTEMI患者一般较STEMI患者预后更差,再住院率高。STEMI患者介入过程往往更需要IABP植入保护。左心室射血分数高是高龄AMI患者预后的保护因素;服用β受体阻滞剂是NSTEMI患者预后的保护因素;而合并外周动脉病是STEMI患者预后的危险因素。

Objective To analyze the clinical characteristics and influenced factors of prognosis in elderly(≥80 years)acute myocardial infarction(AMI)patients who underwent interventional therapy.Methods A total of 260 elderly(≥80 years)AMI patients received interventional therapy from August 2014 to August 2017 were enrolled,which were divided into NSTEMI group(n=121)and STEMI(n=139).The clinical characteristics and prognosis of the two groups were analyzed.Results The mean age of 260 patients with AMI was 83(81,84)years.The age of NSTEMI patients was significantly lower than that of STEMI patients(P=0.03).There were 37 patients with left main stenosis,accounting for 14.2%;187 patients with Killip cardiac function≥2,accounting for 71.9%.There were 151 cases(58.1%)with a lesion count of 3.The proportion of AMI patients with hypertension and diabetes was 72.3% and 42.7%,respectively;the proportion of AMI patients with hyperlipidemia(regardless of NSTEMI patients or STEMI patients)exceeded 90%.Systolic blood pressure(SBP)and left ventricular ejection fraction(LVEF)were significantly higher in the NSTEMI group than in the STEMI group(P<0.01).More NSTEMI patients had a history of remote infarct and postoperative stenting than the STEMI patients and the proportion of patients who took aspirin,statin,and β blockers in the NSTEMI group was also significantly higher than that in the STEMI group(P<0.05).Compared with STEMI group,the proportion of patients who underwent coronary angiography was higher in STEMI group and the proportion of patients implanted with intra-aortic balloon pump(IABP)was significantly lower than that of patients with STEMI(P<0.05).The follow-up results showed that the incidence of re-hospitalization was significantly higher in the NSTEMI group than in the STEMI group(P<0.01).Multivariate logistic regression analysis showed:left ventricular ejection fraction was a protective for prognosis in AMI patients(OR=0.96,95%CI=0.92-1.01,P=0.04);compared with patients who did not takenβblockers,those who tookβblockers had lower risk of poor prognosis in NSTEMI patients(OR=0.32,95%CI=0.11-0.98,P=0.04);peripheral arterial disease was a risk factor for prognosis in STEMI patients(OR=5.93,95%CI=1.50-23.40,P=0.01).Conclusions Elderly(≥80 years old)AMI patients who underwent interventional therapy generally had multiple comorbidities,multiple lesions,poor cardiac function and high mortality.Patients with NSTEMI generally have a worse prognosis than patients with STEMI and have a higher rate of re-hospitalization.The intervention procedure of STEMI patients requires IABP implant protection.High LVEF was a protective factor for elderly AMI patients.Taking β blockers was a protective factor for prognosis elderly NSTEMI patients.Peripheral arterial disease was a risk factor for prognosis in elderly STEMI patients.