CAJ | 학술논문

目的探讨超高龄急性心肌梗死(AMI)患者的院内病死率及相关因素.方法采用回顾性队列研究方法,对自2002年1月至2010年2月期间住院年龄≥80岁超高龄AMI患者进行分析.结果 499例患者住院期间死亡97例,病死率为19.4％,其中ST段抬高急性心肌梗死(STEAMI)297例,死亡69例,病死率23.2％,非ST段抬高心肌梗死202例,死亡28例,病死率13.9％,两者差异有统计学意义(P=0.009).死亡组与存活组临床资料单因素比较显示:死亡组感染、消化道出血、高血压病史、完全性房室传导阻滞、心脏破裂、心功能KillipⅢ、Ⅳ级、肾功能不全及STEAMI的比例显著高于存活组(P值均＜0.05)；而行急诊经皮冠状动脉介入治疗(PCI)的比例显著低于存活组(P＜0.05).多因素logistic回归分析显示:心功能Killip分级、完全性房室传导阻滞、肾功能不全、急诊支架植入及心肌梗死类型为高龄AMI患者院内死亡的独立预测因素.结论心功能Killip分级、完全性房室传导阻滞、肾功能不全、是否行急诊植入支架及MI类型为超高龄AMI患者院内死亡的独立预测因素,对超高龄AMI患者在掌握适应证的前提下行PCI可提高其住院存活率.
목적 탐토초고령급성심기경사(AMI)환자적원내병사솔급상관인소.방법 채용회고성대렬연구방법,대자2002년1월지2010년2월기간주원년령≥80세초고령AMI환자진행분석.결과 499례환자주원기간사망97례,병사솔위19.4％,기중ST단태고급성심기경사(STEAMI)297례,사망69례,병사솔23.2％,비ST단태고심기경사202례,사망28례,병사솔13.9％,량자차이유통계학의의(P=0.009).사망조여존활조림상자료단인소비교현시:사망조감염、소화도출혈、고혈압병사、완전성방실전도조체、심장파렬、심공능KillipⅢ、Ⅳ급、신공능불전급STEAMI적비례현저고우존활조(P치균＜0.05)；이행급진경피관상동맥개입치료(PCI)적비례현저저우존활조(P＜0.05).다인소logistic회귀분석현시:심공능Killip분급、완전성방실전도조체、신공능불전、급진지가식입급심기경사류형위고령AMI환자원내사망적독립예측인소.결론 심공능Killip분급、완전성방실전도조체、신공능불전、시부행급진식입지가급MI류형위초고령AMI환자원내사망적독립예측인소,대초고령AMI환자재장악괄응증적전제하행PCI가제고기주원존활솔.
Objective To explore the in-hospital mortality and its determinants for very eldly (80 + years of age) patients with acute myocardial infarction (AMI).Methods A retrospective cohort method was used.The 499 study subjects were very eldly patients with newly diagnosed AMI consecutively admitted into our department between January 1,2002 and February 22,2010.Results Ninety-seven out of 499 patients died during hospitalization period,with total in-hospital mortality of 19.4％.Multivariable logistic regression analysis showed the independent determinants for mortality of very elderly AMI patients were cardiac Killip grades,complete A-V block,renal dysfunction,stent implant,and the type of AMI.Conclusions The independent determinants for mortality of elderly AMI patients are as following,cardiac Killip grade,complete A-V block,renal dysfunction,stent implant,and the type of MAI.Urgent PCI is safe and effective for some very elderly with AMI,which could improve their survival rate within hospitalization period.