急性心肌梗死3526例的远期预后分析  

Long-term prognosis analysis of 3526 patients with acute myocardial infarction

作　　者：陈卫省 马丽萍[2] CHEN Weisheng;MA Liping(Department of Endocrinology and Cardiovasology,The 73rd Group Army Hospital of PLA,Xiamen 361000,Fujian,China;Department of Cardiovasology,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]中国人民解放军陆军第七十三集团军医院内分泌心血管科,厦门361000 [2]海军军医大学(第二军医大学)第一附属医院心血管内科,上海200433

出　　处：《海军军医大学学报》2024年第12期1487-1494,共8页Academic Journal of Naval Medical University

摘　　要：目的探讨急性心肌梗死(AMI)患者远期死亡的影响因素。方法收集2007年1月至2018年12月于海军军医大学(第二军医大学)第一附属医院心血管内科住院治疗的AMI患者资料,并对院内生存的患者进行随访,通过Cox生存分析和ROC曲线探讨AMI患者远期死亡的影响因素及其预测价值。结果共纳入AMI患者4868例,其中院内死亡261例,失访1081例,共随访至3526例患者。高龄、糖尿病、吸烟及血肌酐、脂蛋白a、肌钙蛋白升高是AMI患者远期死亡的独立危险因素,其中发病年龄每增加1岁远期死亡风险增加7.5%(HR=1.075,95%CI 1.064~1.086,P<0.001),吸烟者发生AMI后的远期死亡风险是不吸烟者的1.261倍(HR=1.261,95%CI 1.023~1.555,P<0.05),糖尿病患者发生AMI后的远期死亡风险是无糖尿病患者的1.307倍(HR=1.307,95%CI 1.073~1.592,P<0.01)。院内行急诊或择期经皮冠状动脉介入术(PCI)、使用他汀类药物、使用β受体阻滞剂和血细胞比容升高是AMI患者远期死亡的保护因素,其中行急诊或择期PCI治疗者远期死亡风险分别降低46.9%和54.8%(HR=0.531,95%CI 0.398~0.707,P<0.001;HR=0.452,95%CI 0.353~0.580,P<0.001),使用他汀类药物的患者远期死亡风险降低39.2%(HR=0.608,95%CI 0.408~0.906,P<0.05),使用β受体阻滞剂的患者远期死亡风险降低17.7%(HR=0.823,95%CI 0.678~0.998,P<0.05)。ROC曲线分析显示,除年龄(AUC值为0.773)外,血肌酐、脂蛋白a、血细胞比容、肌钙蛋白对AMI患者远期死亡的预测价值均较低(AUC值分别为0.636、0.564、0.667、0.524)。结论急诊或择期行PCI治疗、使用他汀类药物、使用β受体阻滞剂能够改善AMI患者的远期预后,而高龄、糖尿病、吸烟则会增加远期死亡风险。Objective To investigate the influencing factors of long-term mortality in patients with acute myocardial infarction(AMI).Methods The data of AMI patients hospitalized in Department of Cardiovasology of The First Affiliated Hospital of Naval Medical University(Second Military Medical University)from Jan.2007 to Dec.2018 were collected.The patients who survived in the hospital were followed up,and the influencing factors and their predictive value for long-term mortality were analyzed by Cox survival analysis and receiver operating characteristic(ROC)curve.Results A total of 4868 patients with AMI were included,of which 261 died in hospital and 1081 were lost to followup.A total of 3526 patients were followed up.Advanced age,diabetes mellitus,smoking,and elevated serum creatinine,lipoprotein(a)and troponin were independent risk factors for long-term mortality in AMI patients.For every 1-year increase in the age of onset,the risk of long-term mortality increased by 7.5%(hazard ratio[HR]=1.075,95%confidence interval[CI]1.064-1.086,P<0.001).The long-term mortality risk of smokers with AMI was 1.261 times that of non-smokers(HR=1.261,95%CI 1.023-1.555,P<0.05).The long-term mortality risk of diabetes patients with AMI was 1.307 times that of non-diabetes patients(HR=1.307,95%CI 1.073-1.592,P<0.01).Primary percutaneous coronary intervention(PCI)or elective PCI,use of statins,use ofβ-blockers,and elevated hematocrit were protective factors for long-term mortality.The risk of long-term mortality in patients treated with primary PCI or elective PCI was reduced by 46.9%and 54.8%,respectively(HR=0.531,95%CI 0.398-0.707,P<0.001;HR=0.452,95%CI 0.353-0.580,P<0.001),reduced by 39.2%in patients treated with statins(HR=0.608,95%CI 0.408-0.906,P<0.05),and reduced by 17.7%in patients treated withβ-blockers(HR=0.823,95%CI 0.678-0.998,P<0.05).ROC curve analysis results showed that except for age(area under curve[AUC]=0.773),the predictive value of serum creatinine,lipoprotein(a),hematocrit,and troponin for long-term mortality was re

关 键 词：急性心肌梗死 随访 远期死亡率 预后 危险因素 

分 类 号：R542.22[医药卫生—心血管疾病]