中国非ST段抬高型心肌梗死患者随访24个月期间死亡的独立危险因素分析  

Risk Factors for Mortality in Patients With Non-ST Segment Elevation Myocardial Infarction in China:Results of 24 Months Follow-up

作　　者：伏蕊[1] 窦克非[1] 许海燕[1] 杨进刚[1] 高传玉 王焱 宋晨曦[1] 高晓津[1] 范肖雪 宋卫华[1] 刘倩倩[1] 王春玥[1] 杨跃进[1] 无 FU Rui;DOU Kefei;XU Haiyan;YANG Jingang;GAO Chuanyu;WANG Yan;SONG Chenxi;GAO Xiaojin;FAN Xiaoxue;SONG Weihua;LIU Qianqian;WANG Chunyue;YANG Yuejin(Coronary Heart Disease Center,National Center for Cardiovascualr Diseases and Fuwai Hospital,CAMS and PUMC,Beijing 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,阜外医院冠心病中心,北京市100037 [2]郑州大学人民医院心内科 [3]厦门大学附属心血管病医院心血管内科 [4]中国急性心肌梗死(CAMI)注册登记研究组

出　　处：《中国循环杂志》2020年第10期985-989,共5页Chinese Circulation Journal

基　　金：国家“十二·五”科技支撑计划课题(2011BAI11B02);中央级公益性科研院所基本科研业务费(2018-F04);中国医学科学院医学与健康科技创新工程基金(2016-12M-009);国家重点研发计划(2018YFC1315602)。

摘　　要：目的:探讨影响中国非ST段抬高型心肌梗死(NSTEMI)患者出院后随访24个月期间死亡的独立危险因素。方法:纳入2013年1月1日至2014年9月30日期间登记于中国急性心肌梗死(CAMI)注册登记研究中的NSTEMI患者共5 509例。主要终点指标是出院后随访24个月期间的全因死亡,依据患者随访期内的生存状态分为死亡组和存活组。构建多因素Cox回归模型,探讨影响NSTEMI患者出院后随访24个月期间死亡的独立危险因素。结果:共计584例(10.6%)患者在出院后24个月随访期间死亡。多因素Cox回归结果提示,年龄(HR=1.051,95%CI:1.042~1.060,P<0.001)、体重指数(HR=0.956,95%CI:0.930~0.984,P=0.002)、既往心肌梗死史(HR=1.414,95%CI:1.140~1.755,P=0.002)、脑卒中史(HR=1.334,95%CI:1.071~1.661,P=0.010)、住院期间未接受再灌注治疗(HR=2.375,95%CI:1.890~2.983,P<0.001)、Killip心功能分级(HR=1.265,95%CI:1.158~1.381,P<0.001)、ST段压低(HR=1.193,95%CI:1.007~1.414,P<0.042)、左心室射血分数(HR=0.979,95%CI:0.972~0.985,P<0.001)、心率(HR=1.007,95%CI:1.004~1.011,P<0.001)、血红蛋白(HR=0.994,95%CI:0.990~0.997,P<0.001)、白细胞计数(HR=1.034,95%CI:1.014~1.055,P=0.001)、血清肌酐(HR=1.002,95%CI:1.001~1.003,P<0.001)、血清钾(HR=1.187,95%CI:1.026~1.374,P=0.021)是患者出院后24个月随访期内死亡的独立危险因素。结论:本研究发现NSTEMI患者出院后随访24个月期间死亡的13个独立危险因素,有助于临床医师对患者进行危险分层并选择最佳诊疗策略。Objectives:To investigate the independent risk factors of 24-month mortality among Chinese patients with non-ST segment elevation myocardial infarction(NSTEMI).Methods:Data from 5509 patients enrolled in the China Acute Myocardial Infarction(CAMI)registry from January 2013 to September 2014 were analyzed.Primary endpoint was 24-month all cause death.Patients were divided into death group and survival group according to survival status.Cox regression model was used to explore the independent risk factors of patients with NSTEMI.Results:A total of 584(10.6%)patients died within 24 months after discharge.Multiple Cox regression analysis indicated that age(HR=1.051,95%CI:1.042-1.060,P<0.001),body mass index(BMI)(HR=0.956,95%CI:0.930-0.984,P=0.002),prior myocardial infarction(HR=1.414,95%CI:1.140-1.755,P=0.002),prior stroke(HR=1.334,95%CI:1.071-1.661,P=0.010),non-reperfusion therapy during hospitalization(HR=2.375,95%CI:1.890-2.983,P<0.001),Killip classification(HR=1.265,95%CI:1.158-1.381,P<0.001),ST-segment depression(HR=1.193,95%CI:1.007-1.414,P<0.042),left ventricular ejection fraction(LVEF)(HR=0.979,95%CI:0.972-0.985,P<0.001),heart rate(HR=1.007,95%CI:1.004-1.011,P<0.001),hemoglobin(HR=0.994,95%CI:0.990-0.997,P<0.001),white blood cell count(HR=1.034,95%CI:1.014-1.055,P=0.001),creatinine level(HR=1.002,95%CI:1.001-1.003,P<0.001)and serum potassium(HR=1.187,95%CI:1.026-1.374,P=0.021)were independent risk factors of 24-month death post discharge.Conclusions:Our study identified 13 independent risk factors of mortality up to 24 months post discharge among Chinese patients with NSTEMI,our data are helpful for the risk stratification and optimal treatment decision making for these patients.

关 键 词：非ST段抬高型心肌梗死 远期死亡 危险因素 预后因素 

分 类 号：R54[医药卫生—心血管疾病]