中国非ST段抬高型心肌梗死患者住院期间死亡的危险因素分析  

Risk Factor Analysis for In-hospital Mortality in Patients With Non-ST Segment Elevation Myocardial Infarction in China

作　　者：伏蕊[1] 窦克非[1] 宋晨曦[1] 杨进刚[1] 许海燕[1] 高晓津[1] 李卫[2] 王杨[2] 刘佳[2] 张玉平 宁彬 万书平[5] 杨跃进[1] 无 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病诊治中心,北京市100037 [2]中国医学科学院北京协和医学院心血管疾病国家重点实验室,北京市100037 [3]山西省长治市人民医院心血管内科 [4]安徽省阜阳市人民医院心血管内科 [5]湖北省天门市第一人民医院心血管内科 [6]代表中国急性心肌梗死注册登记研究组

出　　处：《中国循环杂志》2017年第9期845-849,共5页Chinese Circulation Journal

基　　金：国家"十二.五"科技支撑计划课题(2011BAI11B02);公益性行业科研专项项目(201402001)

摘　　要：目的:探讨中国非ST段抬高型心肌梗死患者(NSTEMI)住院期间死亡的危险因素。方法:纳入2013-01至2014-09期间参加中国急性心肌梗死(CAMI)注册登记研究的NSTEMI患者5 816例。352例患者在住院期间死亡,为住院期死亡组,余住院期间生存的5 464例患者为住院期生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等资料,以住院期间死亡为主要结局指标构建多因素Logistic回归模型,探讨NSTEMI患者住院期间死亡独立危险因素。结果:6.05%(352/5816)的NSTEMI患者在住院期间死亡,两组患者基线资料存在显著差异。多因素Logistic回归分析结果提示,年龄[每增加1岁,比值比(OR)=1.027;95%可信区间(CI):1.014~1.041;P<0.01)、体重指数(每增加1kg/m^2,OR=0.943;95%CI:0.900~0.988;P<0.01)、收缩压(每增加1 mmH g,OR=0.983;95%CI:0.978~0.988;P<0.01)、Killip心功能分级(每增加1级,OR=1.565;95%CI:1.370~1.786;P<0.01)、心跳骤停(OR=3.118;95%CI:1.339~7.262;P<0.01)、ST段压低(OR=1.571;95%CI:1.169~2.110;P<0.01)、新发完全性左束支传导阻滞(OR=4.579;95%CI:1.876~11.177;P<0.01)、血肌酐(每增加1μmol/L,OR=1.004;95%CI:1.002~1.005;P<0.01)、白细胞计数(每增加1×109/L,OR=1.100;95%CI:1.071~1.130;P<0.01)、从不吸烟(OR=2.080;95%CI:1.460~2.962;P<0.01)、既往心肌梗死病史(OR=1.913;95%CI:1.298~2.820;P<0.01)、经皮冠状动脉介入治疗(PCI)史(OR=0.322;95%CI:0.142~0.729;P<0.01)是患者住院期间死亡的独立危险因素。结论:本研究发现12个因素是NSTEMI患者住院期间死亡的独立危险因素,有助于临床医生早期识别高危患者并选择最佳诊疗策略。Objective： To explore the risk factors for in-hospital mortality in patients with non-ST segment elevation myocardial infarction （NSTEMI） in China. Methods： The information of 5816 NSTEM1 patients from 2013-01 to 2014-09 by China Acute Myocardial Infarction （CAMI） registry were extracted. Our research included in 2 groups： In-hospital death group, n=352 and In-hospital survival group, n=5464. The baseline condition, laboratory examination, treatment and the in-hospital outcomes were collected; the independent risk factors for in-hospital mortality were studied by multivariable Logistic regression analysis. Results： 6.05% （352/5816） patients died during hospitalization. The baseline conditions were different between 2 groups. Multivariable Logistic regression analysis indicated that age, BMI, systolic blood pressure, Killip classification, heart arrest, ST-segment depression in ECG, new onset of Complete left bundle branch block, serum creatinine, white blood cells, Count non-smoker, previous history of MI and PCI were the independent risk factors for in-hospital mortality in NSTEMI patients. Conclusion： The above 12 variables were the independent risk factors for in-hospital mortality in NSTEMI patients which should be helpful for identifying the high risk patients at the early stage in clinical practice.

关 键 词：心肌梗死 死亡率 危险因素 

分 类 号：R54[医药卫生—心血管疾病]