75岁以上老年急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗长期死亡危险因素分析  

Risk factors of long term mortality in elderly patients age over 75 years old with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

作　　者：叶绍东[1] 祁雨[1] 孙中伟[1] 唐熠达[1] 李萍[1] 罗琳琳 李琳[1] YE Shao-dong;QI Yu;SUN Zhong-wei;TANG Yi-da;LI Ping;LUO Lin-lin;LI Lin(Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beifing 100037, China)

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心内科,北京100037

出　　处：《中国介入心脏病学杂志》2018年第5期268-273,共6页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨75岁以上老年ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入治疗(PCI)后长期随访中发生死亡事件的危险因素。方法 2011年9月至2014年1月阜外医院共完成PCI 27 397例,完成急诊PCI 1644例,本研究采用回顾性研究方法,连续收集其中老年(年龄≥75岁)STEMI并行直接PCI的患者108例,并持续进行随访,分析患者资料,通过Cox比例风险模型分析死亡事件的独立危险因素。结果所有患者均行直接PCI,平均随访(51.17±17.75)个月。院内死亡5例(4.6%),术后30 d死亡7例(6.5%),随访期间死亡17例(15.7%)。1年死亡的独立危险因素包括女性(HR 5.482,95%CI 1.099～27.333,P=0.038)、心源性休克(HR 11.283,95%CI 2.841～44.805,P=0.001),而支架置入术(HR 0.173,95%CI 0.032～0.943,P=0.043)是死亡事件的保护性因素。长期随访显示,死亡的独立危险因素包括年龄(HR 1.146,95%CI 1.010～1.300,P=0.034)、心源性休克(HR 4.928,95%CI 1.718～14.130,P=0.003)。结论高龄、女性、心源性休克、未行支架置入术是75岁以上老年STEMI患者直接PCI术后发生死亡的危险因素。Objective To investigate the risk factors of short-term and long-term mortality in elderly patients with ST-segment elevation myocardial infarction（STEMI） after primary percutaneous coronary intervention（PPCI）.Methods From Sept. 2011 to Jan. 2014, there were 27 397 PCI cases performedin the Fuwai Hospital. 108 consecutive patients（0.39%） who aged over 75 diagnosed as acute myocardial infarction and underwent PCI were enrolled into this study. Cox proportional hazards model was used to analysis the risk factors of mortality during follow up. Results In the study population, 5 patients（4.63%） died during in-hospital stay, 7 patients（6.5%） died within 30 days after PPCI and 17 patients（15.7%）died during follow up [averaged follow up duration was（51.17±17.75） months]. Independent risk factors of 1-year mortality included female（HR 5.482, 95% CI 1.099–27.333, P=0.038） and cardiac shock（HR11.283, 95% CI 2.841–44.805, P=0.001）. Stent implantation was found to be a protective factor（HR 0.173,95% CI 0.032–0.943, P=0.043）. Independent risk factors of long-term mortality included age（HR 1.146,95% CI 1.010-1.300, P=-0.034）and cardiac shock （HR 4.928, 95% CI 1.718-14.130, P=-0.003）. Conclusions Old age, female, low LVEF, cardic shock and not having stent implantation were independent risk factors for mortality in elderly STEMI patients （≥75 years） who underwent primary PCI.

关 键 词：高龄 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]