左心室射血分数正常的急性心肌梗死患者院内死亡的危险因素分析  

Analysis of risk factors of in-hospital death in acute myocardial infarction patients with normal left ventricular ejection fraction

作　　者：商鲁翔 赵阳[1,2] 李瑞 张文慧 祖克拉.吐尔洪[1] 张疆华 汤宝鹏[1] Shang Luxiang;Zhao Yang;Li Rui;Zhang Wenhui;ZuKe-la TuEr-hong;Zhang Jianghua;Tang Baopeng(Department of Pacing and Electrophysiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Cardiology,Frontier Defence Force General Hospital of Armed Police,Shenzhen 518029,China;Center for Disease Control and Prevention of Shandong,Jinan 250014,China)

机构地区：[1]新疆医科大学第一附属医院起搏电生理科,乌鲁木齐830054 [2]武警边防部队总医院心内科,深圳518029 [3]山东省疾病预防控制中心,济南250014

出　　处：《中国心血管杂志》2018年第5期379-383,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金项目(81460053);新疆维吾尔自治区科技计划项目(201517101)~~

摘　　要：目的探讨左心室射血分数(LVEF)正常的急性心肌梗死(AMI)患者院内死亡的危险因素。方法回顾性选取2014年1月至2017年6月在新疆医科大学第一附属医院心脏中心因AMI入院、LVEF> 50%、Killip分级Ⅰ级或Ⅱ级的患者,根据是否发生院内死亡,分为院内死亡组和对照组。比较两组的基线临床资料,分析院内死亡发生的危险因素。结果共纳入736例患者,其中院内死亡组有45例患者(6. 1%),对照组有691例(93. 9%)。两组患者年龄、男性比例、脑血管病史、既往AMI病史、发病至入院时间、入院方式、梗死部位、血运重建、心电图QRS波宽度、B型利钠肽、心肌酶和肾功能等均有显著差异(均为P <0. 05)。多因素logistic回归结果显示,高龄[比值比(OR)=2. 521]、既往AMI病史(OR=2. 741)、发病至入院时间延长(OR=1. 687)、下级医院转诊(OR=2. 372)、前壁或广泛前壁心肌梗死(OR=3. 231)和肾小球滤过率降低(OR=2. 077)是院内死亡的危险因素,男性(OR=0. 512)和血运重建治疗(OR=0. 237)是院内死亡的保护性因素。结论高龄、既往AMI病史、发病至入院时间延长、下级医院转诊、前壁或广泛前壁心肌梗死和肾功能不全是LVEF正常的AMI患者发生院内死亡的危险因素,而男性和血运重建治疗为保护性因素。Objective To investigate the risk factors of in-hospital death in patients with acute myocardial infarction(AMI)with normal left ventricular ejection fraction(LVEF). Methods From January 2014 to June 2017,patients admitted with AMI diagnosis,LVEF>50%,and Killip classificationⅠorⅡwere included.Participants were divided into two groups,namely,in-hospital death group and control group.Student t-test and chi-square test were used to compare the clinical data of the two groups,logistic regression was used to analyze the risk factors of in-hospital death. Results A total of 736 patients were enrolled,including 45 patients(6.1%)in the in-hospital death group and 691 patients(93.9%)in the control group.There were statistically significant differences in age,gender,history of cerebrovascular disease,history of AMI,disease-to-admission time,method of admission,myocardial infarction site,revascularization,QRS duration,BNP,peak-cTnT,peak-CK-MB,ALT and eGFR(all P<0.05).Multivariate logistic regression results showed that advanced age[odds ratio(OR)=2.521],history of AMI(OR=2.741),prolonged disease-to-admission time(OR=1.687),referral to lower-level hospitals(OR=2.372),anterior wall or extensive anterior myocardial infarction(OR=3.231),and reduced eGFR(OR=2.077)were risk factors for in-hospital death in AMI patients with normal LVEF,while male gender(OR=0.512)and revascularization therapy(OR=0.237)were protective factors. Conclusions Advanced age,previous history of AMI,prolonged onset-to-admission time,referral to lower-level hospitals,anterior wall or extensive anterior myocardial infarction,and reduced renal function are risk factors for in-hospital death in AMI patients with normal LVEF,while male and revascularization therapy are protective factors.

关 键 词：左心室射血分数 急性心肌梗死 院内死亡 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]