急性心肌梗死患者急诊冠脉介入治疗院内死亡危险因素分析  

Risk factors for in-hospital mortality in patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention

作　　者：刘安恒 郭勍 白旭鹏 李利军[1] 罗建平 LIU Anheng;GUO Qing;BAI Xupeng;LI Lijun;LUO Jianping(Department of Cardiology,Beijing Jingmei Group General Hospital,Beijing 102300,China)

机构地区：[1]北京京煤集团总医院心内科,北京102300

出　　处：《军事医学》2025年第2期114-118,共5页Military Medical Sciences

摘　　要：目的 观察急性心肌梗死患者接受急诊冠脉介入治疗院内死亡的危险因素。方法 纳入2016年9月至2022年12月北京京煤集团总医院行急诊冠脉介入治疗的急性心肌梗死患者908例,根据院内结局分为死亡组(36例)及存活组(872例)。比较两组患者的一般资料、临床指标、冠脉造影、急诊冠脉介入治疗及其并发症,应用多因素Logistic回归分析院内死亡的危险因素。结果 死亡组年龄及血肌酐水平高于存活组(P<0.05),肾小球滤过率及血红蛋白水平低于存活组(P<0.05)。糖尿病、脑梗死、心源性休克、左主干罪犯病变、快速性室性心律失常、冠脉介入治疗术后罪犯血管TIMI血流<3级及主动脉内球囊反搏置入在死亡组的比例均高于存活组(P<0.05)。多因素Logistic回归分析结果显示年龄、心源性休克、快速性室性心律失常及介入术后罪犯血管TIMI血流<3级对急诊冠脉介入治疗院内死亡的影响具有统计学意义(P<0.05)。结论 年龄、心源性休克、冠脉介入治疗术后罪犯血管TIMI血流<3级及快速性室性心律失常是急性心肌梗死患者急诊冠脉介入治疗院内死亡的独立危险因素。Objective To study the risk factors for in-hospital mortality in patients with acute myocardial infarction(AMI)undergoing emergency percutaneous coronary intervention(EPCI).Methods Nine hundred and eight patients with acute myocardial infarction(AMI)who underwent EPCI at Beijing Jingmei Group General Hospital between September 2016 and December 2022 were enrolled and divided into an in-hospital death group(36 cases)and a survival group(872 cases)based on in-hospital outcomes.The basic information,clinical indicators,results of coronary angiography,outcomes of EPCI,and complications were compared between the two groups.Multiple logistic regression analysis was conducted to identify the risk factors for in-hospital mortality during EPCI.Results The age and serum creatinine levels of the death group were higher than those of the survival group(P<0.05),and the estimated glomerular filtration rate(eGFR)and hemoglobin(Hb)levels were lower than those of the survival group(P<0.05).The proportion of diabetes mellitus,cerebral infarction,cardiogenic shock,left main culprit lesion,rapid ventricular arrhythmia,TIMI flow grade<3 after EPCI for culprit vessel,and intra-aortic balloon pump(IABP)implantation in the death group were higher than those of the survival group(P<0.05).The results of multiple logistic regression analysis showed that age,cardiogenic shock,TIMI flow grade<3 after culprit vessel intervention,and rapid ventricular arrhythmia had a statistically significant impact on in-hospital mortality in EPCI(P<0.05).Conclusion Age,cardiogenic shock,TIMI flow grade<3 after PCI for culprit vessels,and rapid ventricular arrhythmia are independent risk factors for in-hospital mortality in EPCI patients with AMI.

关 键 词：急性心肌梗死 急诊冠脉介入治疗 心源性休克 院内死亡 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]