高龄急性心肌梗死患者冠状动脉造影特点及其预后危险因素分析

Analysis of characteristics of coronary angiography and prognostic risk factors in senile patients with acute myocardial infarction

目的分析高龄急性心肌梗死(AMI)患者冠状动脉造影(CAG)的特点及其预后危险因素。方法回顾性分析2017年01月—2020年01月成都医学院第一附属医院心血管内科收治的329例高龄AMI患者的临床资料,分析他们的CAG特点。均行经皮冠状动脉介入(PCI)治疗,术后对患者进行1年随访,记录患者生存状况,分为存活组(n=284)和死亡组(n=45),比较2组临床资料,并分析危险因素。结果329例高龄AMI患者中,单支病变78例(23.71%),2支病变91例(27.661%),3支病变160例(48.63%);172例病变位于LAD,32例病变位于RCA,98例病变位于LCX,27例病变位于近段病变。单因素分析显示,糖尿病、高血压、陈旧性心肌梗死病史、Killips分级、梗死面积、病变部位、罪犯血管、病变支数、冠脉血流、ST段回落情况、室颤及SCr、cTnI、CRP、e GFR、Hb、LVEF水平与高龄AMI患者死亡相关(P<0.001)。Logistic多因素回归分析显示,糖尿病、高血压、陈旧性心肌梗死病史、Killips分级高、梗死面积大、病变位于前壁、罪犯血管位于梗死近段、病变支数为3支、冠脉无血流和慢血流、ST段回落不良、室颤、SCr、cTnⅠ及CRP升高和e GFR、Hb、LVEF降低可增加高龄AMI患者的死亡风险(P<0.05)。结论高龄AMI患者以三支病变多见,且糖尿病、高血压、陈旧性心肌梗死病史、Killips分级高、梗死面积大、病变位于前壁、罪犯血管位于梗死近段、病变支数为3支、冠脉无血流和慢血流、ST段回落不良、室颤、SCr、cTnⅠ及CRP升高和e GFR、Hb、LVEF降低可作为AMI预后的预测因子,可为临床识别高危人群提供参考。

Objective To analyze the characteristics of coronary angiography(CAG)and prognostic risk factors in senile patients with acute myocardial infarction(AMI).Methods The clinical data of 329 senile AMI patients admitted to First Affiliated Hospital of Chengdu Medical College from January 2017 to January 2020 were retrospectively analyzed,and their characteristics of CAG were analyzed.All patients underwent percutaneous coronary intervention(PCI).They were followed up for1 year after operation and their survival status was recorded.According to their survival status,they were divided into survival group(n=284)and death group(n=45).The clinical data of the two groups were compared and the risk factors were analyzed.Results Among 329 senile patients with AMI,78 ones(23.71%)had single vessel disease,91 ones(27.661%)had double vessel disease,and 160 ones(48.63%)had triple vessel disease.172 lesions were located in LAD,32 ones in RCA,98 ones in LCX,and 27 ones in proximal lesions.Univariate analysis showed that diabetes,hypertension,history of old myocardial infarction,Killips grade,infarct size,lesion location,criminal vessel,number of lesions,coronary blood flow,ST segment fall,ventricular fibrillation and the levels of SCr,cTnⅠ,CRP,EGFR,Hb,LVEF were associated with death in senile patients with AMI(P<0.001).Logistic multifactor regression analysis showed that diabetes,hypertension,history of old myocardial infarction,high grade of Killips,large infarct size,lesion in anterior wall,criminal vessels in the near segment of infarction,3 lesions,no coronary blood flow and slow blood flow,poor ST segment fall,ventricular fibrillation and the increased levels of SCr,cTnⅠand CRP and the decreased levels of e GFR,Hb,LVEF could increase the risk of death in senile patients with AMI(P<0.05).Conclusion Three vessel lesions are more common in senile patients with AMI.The history of diabetes,hypertension,old myocardial infarction,high Killips grade,large infarction size,esions located in the anterior wall,criminal vessels in the near segment of infarction,3 lesions,no coronary blood flow and slow blood flow,poor ST segment fall,ventricular fibrillation and the increased levels of SCr,cTnⅠand CRP,and the decreased levels of eGFR,Hb,LVEF can be used as predictors of the prognosis of AMI,which can provide references for clinical identification of high-risk population.