中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2013年
7期
549-558
,共10页
王娟%杨艳敏%朱俊%谭慧琼%刘力生
王娟%楊豔敏%硃俊%譚慧瓊%劉力生
왕연%양염민%주준%담혜경%류력생
心肌梗死%心律失常%死亡率%预后
心肌梗死%心律失常%死亡率%預後
심기경사%심률실상%사망솔%예후
Myocardial infarction%Arrhythmia%Mortality%Prognosis
目的 探讨ST段抬高的急性心肌梗死(STEMI)合并致死性心律失常患者的30 d预后和影响病死率的独立危险因素,为这类患者的死亡风险评估提供参考.方法 回顾性分析国际多中心CREATE研究的中国STEMI合并心律失常患者资料,用单变量和多变量logistic回归分析这部分患者的基线特征因素和治疗因素与30 d病死率的相关性.结果 合并致死性心律失常718例患者平均年龄(66.1±11.9)岁,男性占62.4％,30 d的病死率为52.9％(380例).将全部变量进行多因素logistic回归分析显示年龄(OR=1.82,95％ CI:1.449 ～2.285)、前壁梗死(OR=4.419,95％ CI:2.645～7.384)、心率＞60次/min(OR =3.32,95％ CI:1.898～5.808)、KillipⅣ级(OR=3.686,95％ CI:1.686 ～8.060)、糖化血红蛋白＜5.6％(OR =2.564,95％ CI:1.199～5.484)、未用血管紧张素转化酶抑制剂(ACEI)(OR=1.827,95％ CI:1.099～ 3.038)、未用降脂治疗(OR=2.034,95％ CI:1.196 ～ 3.458)是30 d病死率增加的独立危险因素.仅包含基线特征变量的logistic回归分析显示,上述前5项基线变量是死亡的独立基线危险因素.受试者工作特征曲线(ROC)分析2个回归模型均有较高的判别死亡高危患者的能力,ROC下面积分别为0.830(95％ CI:0.796～0.865)和0.866(95％ CI:0.835 ～0.896).结论 STEMI并发致死性心律失常患者30 d病死率超过50％,年龄、前壁心肌梗死、心率≥60次/min、Killip分级Ⅳ级和未用ACEI、未用降脂治疗等是影响30 d病死率的独立危险因素.
目的 探討ST段抬高的急性心肌梗死(STEMI)閤併緻死性心律失常患者的30 d預後和影響病死率的獨立危險因素,為這類患者的死亡風險評估提供參攷.方法 迴顧性分析國際多中心CREATE研究的中國STEMI閤併心律失常患者資料,用單變量和多變量logistic迴歸分析這部分患者的基線特徵因素和治療因素與30 d病死率的相關性.結果 閤併緻死性心律失常718例患者平均年齡(66.1±11.9)歲,男性佔62.4％,30 d的病死率為52.9％(380例).將全部變量進行多因素logistic迴歸分析顯示年齡(OR=1.82,95％ CI:1.449 ～2.285)、前壁梗死(OR=4.419,95％ CI:2.645～7.384)、心率＞60次/min(OR =3.32,95％ CI:1.898～5.808)、KillipⅣ級(OR=3.686,95％ CI:1.686 ～8.060)、糖化血紅蛋白＜5.6％(OR =2.564,95％ CI:1.199～5.484)、未用血管緊張素轉化酶抑製劑(ACEI)(OR=1.827,95％ CI:1.099～ 3.038)、未用降脂治療(OR=2.034,95％ CI:1.196 ～ 3.458)是30 d病死率增加的獨立危險因素.僅包含基線特徵變量的logistic迴歸分析顯示,上述前5項基線變量是死亡的獨立基線危險因素.受試者工作特徵麯線(ROC)分析2箇迴歸模型均有較高的判彆死亡高危患者的能力,ROC下麵積分彆為0.830(95％ CI:0.796～0.865)和0.866(95％ CI:0.835 ～0.896).結論 STEMI併髮緻死性心律失常患者30 d病死率超過50％,年齡、前壁心肌梗死、心率≥60次/min、Killip分級Ⅳ級和未用ACEI、未用降脂治療等是影響30 d病死率的獨立危險因素.
목적 탐토ST단태고적급성심기경사(STEMI)합병치사성심률실상환자적30 d예후화영향병사솔적독립위험인소,위저류환자적사망풍험평고제공삼고.방법 회고성분석국제다중심CREATE연구적중국STEMI합병심률실상환자자료,용단변량화다변량logistic회귀분석저부분환자적기선특정인소화치료인소여30 d병사솔적상관성.결과 합병치사성심률실상718례환자평균년령(66.1±11.9)세,남성점62.4％,30 d적병사솔위52.9％(380례).장전부변량진행다인소logistic회귀분석현시년령(OR=1.82,95％ CI:1.449 ～2.285)、전벽경사(OR=4.419,95％ CI:2.645～7.384)、심솔＞60차/min(OR =3.32,95％ CI:1.898～5.808)、KillipⅣ급(OR=3.686,95％ CI:1.686 ～8.060)、당화혈홍단백＜5.6％(OR =2.564,95％ CI:1.199～5.484)、미용혈관긴장소전화매억제제(ACEI)(OR=1.827,95％ CI:1.099～ 3.038)、미용강지치료(OR=2.034,95％ CI:1.196 ～ 3.458)시30 d병사솔증가적독립위험인소.부포함기선특정변량적logistic회귀분석현시,상술전5항기선변량시사망적독립기선위험인소.수시자공작특정곡선(ROC)분석2개회귀모형균유교고적판별사망고위환자적능력,ROC하면적분별위0.830(95％ CI:0.796～0.865)화0.866(95％ CI:0.835 ～0.896).결론 STEMI병발치사성심률실상환자30 d병사솔초과50％,년령、전벽심기경사、심솔≥60차/min、Killip분급Ⅳ급화미용ACEI、미용강지치료등시영향30 d병사솔적독립위험인소.
Objective To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI)complicated with fatal arrhythmia.Methods We analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial.Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables.Results The overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [(66.1 ± 11.9) years and 62.4％ male] was 52.9％.Logistic regression analysis showed that age (OR =1.82,95％ CI:1.449-2.285),anterior infarction (OR =4.419,95％ CI:2.645-7.384),heart rate ＞ 60 bpm (OR =3.32,95％ CI:1.898-5.808),killip class Ⅳ (OR =3.686,95％ CI:1.684-8.06),admission hemoglobin A1 c ＜ 5.6％ (OR =2.564,95％ CI:1.199-5.484),no use of ACEI (OR =1.827,95％ CI:1.099-3.038) and no use of lipid-lowing drugs (OR =2.034,95％ CI:1.196-3.458) were independent risk factors for short term mortality after STEMI.The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0.830 (95％ CI:0.796-0.865) and 0.866 (95％ CI:0.835-0.896),respectively.Conclusion The 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high.Age,anterior infarction,heart rate ＞ 60 bpm,killip class Ⅳ,admission hemoglobin Alc level ＜ 5.6％,no use of ACEI and no use of lipid-lowing drugs are independent risk factors for 30-day mortality in these patients.
