摘要
目的:评价不同Killip分级的中国急性心肌梗死(AMI)患者的临床特征、治疗和预后情况。方法:选择2013-01至2014-09中国急性心肌梗死注册研究(CAMI)入选的在AMI发作7天之内25 044例患者,包括18 831例(75.2%)ST段抬高型心肌梗死(STEMI)和6 213例(24.8%)非ST段抬高型心肌梗死(NSTEMI)。根据临床表现进行Killip分级。比较KillipⅠ~Ⅳ级患者的临床表现、诊治过程及院内预后的差异。结果:Killip I^IV级患者的比例分别为74.2%、16.8%、4.9%和4.1%。与Killip I级患者相比,KillipⅡ~Ⅳ级患者中,女性、糖尿病、高血压、NSTEMI和射血分数<40%、应用主动脉内球囊反搏(IABP)的比例较高,年龄较大,就诊时心率较快,有典型胸痛症状的比例较低(P均<0.0001);KillipⅠ~Ⅳ级患者接受直接冠状动脉介入治疗(PCI)的比例分别为39.2%、28.6%、13.2%和26.8%;Killip III级使用直接PCI的比例最低(P<0.001)。Killip级别较高的患者使用抗血小板、他汀药、β受体阻滞剂和血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)等药物治疗的比例较低(P均<0.001)。KillipⅠ~Ⅳ级的院内死亡率分别为4.0%、9.2%、17.6%和35.1%。多因素分析显示,与Killip I级患者相比,KillipⅢ级[优势比(OR):1.721,95%可信区间(CI):1.132~2.617]和KillipⅣ级(OR=3.604,95%CI:2.485~5.226)的院内死亡率明显升高。结论:中国AMI患者中,Killip分级≥Ⅱ级的患者约占四分之一。Killip分级较高的患者,接受直接PCI和有循证医学证据的药物比例反而较低,尤其是Killip III级的患者。Killip分级与院内死亡率较高有关。
Objective： To evaluate the clinical features, treatment and prognosis in acute myocardial infarction （AMI） patients withdifferent Killip grades. Methods： A total of 25044 AMI patients within 7 days of onset from 2003-01 to 2014-09 by CAMI registry were enrolled. There were 18831 （75.2%） patients with ST elevation myocardial infarction （STEMI） and 6213 （24.8%） with NSTEMI. Killip grades I, II, III and IV groups were classiifed by clinical features, the diagnostic and treatment procedures and in-hospital prognosis were compared among the patients with different Killip grades. Results： The patient’s proportion in Killip grade I, II III and IV groups were 74.2%, 16.8%, 4.9% and 4.1% respectively. Compared with Killip grade I group, Killip grade II, III, IV groups had more patients with female gender, diabetes, hypertension, NSTEMI and ejection fraction〈40%, more patients received IABP, the patients were with elder age, higher heart rate at clinical visiting and less typical＆amp;nbsp;chestpainsym ptoms, allP〈0.001. The patients received primary PCI in Killip grade I, II III and IV groups were 39.2%, 28.6%, 13.2% and 26.8% respectively, the lowest primary PCI rate was in Killip grade III group,P〈0.001. The patients with higher Killip grades had the lower medication rates of anti-platelet therapy, statins, beta blockers and ACEI/ARB, allP〈0.001. The in-hospital mortality in Killip grade I, II III and IV groups were 4.0%, 9.2%, 17.6% and 35.1% respectively. Multiple factor analysis showed that compared with Killip grade I group, Killipgrade III group （OR=1.721, 95% CI 1.132-2.617） and Killip grade IV group （OR=3.604, 95% CI 2.485-5.226） had obviously increased in-hospital mortality. Conclusion： By our research, about 1/4 AMI patients were with heart failureat certain degree in China. The patients with higher Killip grades were having lower chance to receive primary PCI and having less medication instead especially in Killip grade III patients. Killipgrades were related to in-hospital mortality.
作者
陈冬生
栾献亭
杨进刚
王志杰
李卫
王杨
许海燕
高晓津
伏蕊
杨跃进
CHEN Dong-sheng LUAN Xian-ting YANG Jin-gang Wang Zhi-jie LI Wei WANG Yang XU Hai-yan GAO Xiao-jin FU Rui YANG Yue-jin(on behalf of China Acute Myocardial Infarction Registry,Department of Cardiology, The Second People＇s Hospital of Pingdingshan, Pingdingshan （467000）, Henan, Chin)
出处
《中国循环杂志》
CSCD
北大核心
2016年第9期849-853,共5页
Chinese Circulation Journal
基金
国家“十二·五”科技支撑计划课题:心血管疾病及其危险因素监测、预防和治疗关键技术研究(2011BAI11B02)
国家卫生和计划生育委员会公益性行业科研专项(201402001)
