老年急性ST段抬高型心肌梗死患者溶栓疗效和住院死亡相关因素分析

Efficacy of thrombolytic therapy and analysis of related factors of hospital death in elderly patients with acute ST-segment elevation myocardial infarction

目的分析老年急性ST段抬高型心肌梗死(STEMI)患者溶栓治疗的疗效并评价影响住院死亡的因素。方法河南省73家医院连续纳入1226例急性STEMI患者,应用瑞替普酶溶栓治疗。比较<65岁组和≥65岁组急性STEMI患者的心肌梗死血管再通率、心血管事件和出血事件等指标差异;比较老年急性STEMI患者死亡组与存活组之间的各因素差异,并使用多因素Logistic回归分析差异的相关因素。结果排除溶栓过程中死亡的7例患者,最终对1219例急性STEMI患者进行分析。<65岁组899例(73.7%),≥65岁组320例(26.3%)。梗死血管再通率在<65岁组和≥65岁组中分别为89.4%和89.1%(P=0.85)。与<65岁组相比,≥65岁组溶栓后住院期间死亡率高(1.6%vs.4.7%,P=0.002)、心力衰竭和休克(0.8%vs.2.2%,P=0.04)发生率高。在≥65岁组中,住院死亡患者15例(4.7%),住院存活患者305例(95.3%)。与住院存活老年患者(≥65岁)相比,住院死亡老年患者男性比例和心肌梗死血管再通率均较低,心功能Killip分级、心力衰竭、休克和心肌再梗死的发生率均较高(P均<0.05)。经过多因素Logistic回归分析后,女性(OR=3.54,95%CI:1.09~11.43)和Killip分级高(OR=1.72,95%CI:1.00~2.94)的老年患者发生溶栓后死亡的风险增加,心肌梗死后血管再通(OR=0.07,95%CI:0.02~0.21)的老年患者发生溶栓后死亡的风险降低。结论溶栓可作为老年急性STEMI患者的早期再灌注治疗手段。与非老年患者相比,老年患者溶栓后住院死亡率较高,女性和Killip分级高是影响住院死亡的危险因素。

Objective To investigate the efficacy of thrombolytic therapy in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)and evaluate the factors affecting hospital death.Methods 1226 patients with acute STEMI were continuously enrolled from 73 hospitals in Henan Province,and reteplase was used for thrombolytic therapy.The differences in infarct vessel recanalization rates,cardiovascular events,and bleeding events were compared between acute STEMI patients aged<65 years and≥65 years.The differences in various factors between the death and the survival groups of elderly patients with acute STEMI were compared,and the relevant factors of the difference were analyzed by multivariate Logistic regression.Results 7 patients who died during thrombolysis were excluded and 1219 patients with acute STEMI were finally analyzed.The patients aged<65 years accounted for 899 cases(73.7%),and those aged≥65 years accounted for 320 cases(26.3%).The recanalization rates of infarcted vessels were 89.4%and 89.1%in patients aged<65 years and those aged≥65 years,respectively(P=0.85).Compared with those aged<65 years,patients aged≥65 years had higher rates of mortality after thrombolysis(1.6%vs.4.7%,P=0.002),heart failure and shock(both 0.8%vs.2.2%,P=0.04)during hospitalization.In the group of patients aged≥65 years,15 cases(4.7%)died and 95.3%(305 cases)survived in hospital.Compared with hospitalized surviving elderly patients(≥65 years),the proportion of men and the recanalization rate of infarcted vessels were lower;The level of Killip classification and rates of heart failure,shock and reinfarction were higher in elderly patients who died in hospital(P<0.05).With multivariate logistic regression analysis,females(OR=3.54,95%CI:1.09~11.43)and high Killip grades(OR=1.72,95%CI:1.00~2.94)were associated with a higher risk of death in elderly patients.Recanalization was associated with a lower risk of death in elderly patients(OR=0.07,95%CI:0.02~0.21).Conclusion Thrombolysis can be used as an early reperfusion therapy for elderly patients with acute STEMI.Compared with patients aged<65 years,those aged≥65 years have a higher hospital mortality rate after thrombolysis.Females and higher Killip grades are risk factors affecting hospital deaths.