老年人急性心肌梗死临床特点及短期预后的影响因素

THE RELATIONSHIP BETWEEN MORTALITY AND CLINICAL CHARACTERISTIC OF ACUTE MYOCARDIAL INFARCTION IN ELDERLY

目的研究老年人急性心肌梗死的临床特征及短期预后的影响因素。方法将共742例急性心肌梗死病人分成老年组(年龄≥65岁)和非老年组(年龄<65岁),研究老年人急性心肌梗死临床特点及短期预后的影响因素。结果老年组中高血压、糖尿病、不典型症状、严重心律失常、休克、接受保守治疗均高于非老年组(P<0.05)。老年组的住院死亡率高于非老年组(21.2%vs8.0%,P<0.001)。再灌注治疗,尤其是急诊介入治疗可以降低老年组住院死亡率(介入vs溶栓vs保守:24.6%vs18.7%vs8.0%,P=0.022)。严重室性心律失常(OR=13.36(5.68-31.41)),休克(OR=6.646(3.455～12.782)),广泛前壁侧壁心梗(OR=2.652(1.338～5.257))是老年人急性心肌梗死短期预后的独立危险因素(P<0.05),而急诊介入治疗(OR=0.258(0～0.856),P<0.05)是改善短期预后的独立因素。结论老年急性心肌梗死患者临床表现不典型,往往存在更多合并症和并发症,病情危重,死亡率高。但再灌注治疗,尤其是急诊介入治疗仍可以有效改善其短期预后,在临床上应积极诊治老年急性心肌梗死患者。

Objective To study the clinical characteristic of acute myocardial infarction in elderly and factors that have been effected on short-term prognosis. Methods The total 742 pts were divided into two groups: senile group(≥65ys),junior group(< 65ys). Results The morbidity of hypertension, diabetes mellitus ,atypical symptom MI, severe arrhythmia and shock were higher in senile group(P< 0.05).The in-hospital mortality was also higher(senile group vs junior group: 21.2%vs 8.0%,P< 0.001).The prognosis could be improved by reperfusion therapy, especially the emergency PCI,(PCI vs thromblysis vs conventional therapy: 24.6%vs 18.7%vs 8.0%,P=0.022).Severe ventricular arrhythmia(OR=13.36(5.68～31.41));shock(OR=6.646(3.455～12.782));extensive anterior and lateral wall infarction(OR=2.652(1.338～5.257))were the independent risk factors of in-hospital mortality(P< 0.05).Emergency PCI was the only independent factor for improving the survival. Conclusions The symptoms of acute myocardial infarction in elder are apt to be atypical, with more co-existing diseases and more severe complications. The prognosis is worse than in junior. But reperfusion therapy, especially the PCI, can improve the survival. Thus, more attention should be paid to the elder AMI patients, and give them appropriate diagnosis and treatment.