中青年与老年急性ST段抬高心肌梗死患者的临床特征比较及近期预后影响因素分析被引量：23

Analysis of the Clinical Features and Short-term Prognosis in Elderly and Middle-aged Patients with Acute ST-segment Elevation Myocardial Infarction

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摘要目的对比分析中青年和老年急性ST段抬高心肌梗死(ASTEMI)患者的临床特征及影响其近期预后的因素。方法将1993—2006年我院心内科收治的首次发作且发病24 h内入院的1 278例ASTEMI患者分为中青年组(年龄<60岁)和老年组(年龄≥60岁),对比分析两组人群的基本临床资料、住院期间的治疗、并发症及预后。结果两组患者的性别构成,高血压、糖尿病及脑卒中史者比例,有发病诱因、症状不典型比例,发病至就诊时间,入院收缩压、肌酸激酶同工酶峰值、白细胞计数、入院空腹血糖、三酰甘油、高密度脂蛋白胆固醇、肌酐水平,射血分数,冠脉病变比例间差异均有统计学意义(P<0.05)。两组患者住院期间接受抗凝、血管紧张素转换酶抑制剂、β-受体阻滞剂、他汀类药物、溶栓治疗、经皮冠状动脉介入治疗的比例间差异均有统计学意义(P<0.05)。两组患者住院期间病死率,心源性休克、室壁破裂发生率间差异均有统计学意义(P<0.05)。以是否发生住院死亡为因变量,以两组患者住院期间临床资料和治疗情况中有统计学差异的变量为自变量,进行Logistic回归分析。结果显示,影响老年患者住院期间死亡率的因素是年龄、高血压病史、入院空腹血糖、肌酐水平、较少接受β-受体阻滞剂及经皮冠状动脉介入治疗(P<0.05)。结论老年ASTEMI患者住院病死率较中青年高,与其合并较多危险因素且未接受更积极的治疗有关。 Objective To analysis of the clinical features and short term prognosis in elderly and middle aged patients with acute ST segment elevation myocardial infarction （STEMI）. Methods Totally, 1278 patients with first STEMI who were admitted to our institute within 24 h of symptoms onset were divided into two groups： elderly group （/〉60 years） and middle aged group （〈60 years）, and a retrospective analysis was conducted with clinical characteristics, treatment data, in hospital complications and mortality. Results Compared with middle aged STEMI patients, elderly patients had a higher rate of fe male, and a greater incidence of hyperension and diabetes mellitus and stroke, higher levels of fasting plasma glucose and creati nine, lower ejection fraction and a higher proportion of multi vessel or left main coronary artery disease. Elderly patients were less likely to receive anticoagulants, angiotensin converting enzyme inhibitors, beta blockers, statins, thrombolytic therapy and percutaneous coronary intervention. Logistic regression analysis revealed that age, hypertension, fasting plasma glucose and less received beta blockers and percutaneous coronary intervention were independently associated with the in hospital mortality in elderly patients with acute STEMI. Conclusion The higher in hospital mortality after an acute STEMI in elderly compared with middle aged patients could be explained by older age, more concomitant diseases and less aggressively treated.

作者谭静华琦

机构地区首都医科大学宣武医院心脏科

出处《中国全科医学》 CAS CSCD 北大核心 2012年第29期3354-3356,共3页 Chinese General Practice

关键词急性ST段抬高心肌梗死老年人中年人预后 Acute ST- segment elevation myocardial infarction Aged Middle aged Prognosis

分类号 R542.22 [医药卫生—心血管疾病]

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