我国急性心肌梗死病人死亡危险因素的Meta分析

Risk factors of death in patients with acute myocardial infarction in China:a Meta-analysis

目的:系统评价急性心肌梗死病人死亡的危险因素,为降低急性心肌梗死病人死亡率提供依据。方法:计算机检索PubMed、中国生物医学文献数据库、中国知网、万方数据库、维普数据库,搜集建库至2020年6月30日关于急性心肌梗死病人死亡相关危险因素的文献。采用RevMan 5.3软件对纳入的文献进行分析。结果:共纳入21篇文献,包括17项相关危险因素,Meta分析结果显示,年龄[SMD=0.88,95%CI(0.74,1.01),P<0.001]、性别[OR=0.45,95%CI(0.41,0.50),P<0.00001]、吸烟[OR=0.66,95%CI(0.50,0.87),P=0.003]、糖尿病[OR=2.27,95%CI(1.88,2.73),P<0.00001]等12个危险因素差异有统计学意义;再灌注治疗[OR=0.34,95%CI(0.25,0.46),P<0.001]、经皮冠状动脉介入术[OR=0.17,95%CI(0.12,0.22),P<0.001]、左室射血分数降低[SMD=-0.93,95%CI(-1.06,-0.80),P<0.001]3个保护因素差异有统计学意义。结论:现有证据表明,高龄、有吸烟史、糖尿病史、脑卒中、高血压史、心肌梗死史的急性心肌梗死病人死亡的可能性较大,而及早进行再灌注治疗、经皮冠状动脉介入术及降低左心室射血分数有利于急性心肌梗死病人存活。

Objective:To systematically evaluate the risk factors of death in patients with acute myocardial infarction,and to provide evidence for reducing the mortality of patients with acute myocardial infarction.Methods:Articles risk factors related to death in patients with acute myocardial infarction were retrieved from PubMed,CBM,CNKI,WanFang Database and VIP.The search time was from the establishment of each database to June 30,2020.RevMan 5.3 software was used for analysis.Results:A total of 21 articles were included,including 17 related risk factors.Meta analysis results showed that age[SMD=0.88,95%CI(0.74,1.01),P<0.001],gender[OR=0.45,95%CI(0.41,0.50),P<0.00001],smoking[OR=0.66,95%CI(0.50,0.87),P=0.003],diabetes mellitus[OR=2.27,95%CI(1.88,2.73),P<0.00001]and other 12 risk factors were statistically significant.Three protective factors,such as reperfusion therapy[OR=0.34,95%CI(0.25,0.46),P<0.001]and percutaneous coronary intervention[OR=0.17,95%CI(0.12,0.22),P<0.001]and LVEF reduced[SMD=-0.93,95%CI(-1.06,-0.80),P<0.001]were statistically significant.Conclusions:Current evidence shows that patients with acute myocardial infarction who are elderly,have a history of smoking,diabetes,stroke,hypertension,and myocardial infarction are more likely to die,and early reperfusion therapy,percutaneous coronary intervention and reduce decreased left ventricular ejection fraction are beneficial to the survival of patients with acute myocardial infarction.