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

摘要

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 classificationⅠ or Ⅱ were 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.%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.