老年非ST段抬高型急性心肌梗死患者临床特征及预后影响因素

摘要

目的 探讨老年非ST段抬高型急性心肌梗死(NSTEMI)患者的临床特征及预后影响因素.方法 135例老年急性心肌梗死患者,其中NSTEMI患者72例、ST段抬高型急性心肌梗死(STEMI)患者63例,比较NSTEMI与STEMI患者的临床资料,同时采用Cox回归模型分析影响老年NSTEMI患者预后的相关因素.结果 NSTEMI、STEMI患者中糖尿病分别为30、12例,高血压分别为49、31例,持续性胸痛分别为40、53例,心力衰竭分别为45、27例,肌酸激酶峰值分别为(829.55±125.64)、(2354.45±351.01)IU/L,肌钙蛋白I峰值分别为(0.86±0.24)、(1.86±0.64)ng/mL,两者比较,P均＜0.05.出院后1年期间内,NSTEMI患者再发心绞痛发生率、心力衰竭发生率和病死率均高于STEMI患者(24.3%vs.11.7%,18.6%vs.6.7%,25.7%vs.8.3%),P均＜0.05.高龄(＞65岁)(HR=2.13)、心力衰竭(HR=3.37)和入院时Killip≥3级(HR=1.79)为老年NSTEMI患者近期预后的危险因素,服用阿司匹林(HR=0.51)为老年NSTEMI患者近期预后的保护因素.结论 与老年STEMI患者相比,老年NSTEMI患者合并糖尿病、高血压和心力衰竭更多,持续性胸痛更少,肌酸激酶峰值和肌钙蛋白I峰值更低.老年NSTEMI患者远期预后较差,高龄(＞65岁)、伴心力衰竭和入院时Killip≥3级老年NSTMEI患者预后风险增加,服用阿司匹林老年NSTMEI患者预后风险降低.%Objective To investigate the clinical characteristics and prognostic factors of elderly patients with non-ST-seg-ment elevation acute myocardial infarction (NSTEMI).Methods Totally 135 elderly patients with acute myocardial infarction, including 72 patients with NSTEMI and 63 patients with ST segment elevation acute myocardial infarction (STEMI) were select-ed.The clinical data between patients with NSTEMI and with STEMI were compared .Cox regression model was used to analyze the prognostic factors for elderly patients with NSTEMI .Results The NSTEMI elderly patients had more cases of patients with diabetes mellitus (30 vs.12), hypertension (49 vs.31) and heart failure (45 vs.27) than STEMI elderly patients and had less cases of persistent chest pain (40 vs.53), lower levels of peak creatine kinase〔(829.55 ±125.64) IU/L vs.(2354.45 ± 351.01) IU/L〕and troponin I peak〔(0.86 ±0.24) ng/mL vs.(1.86 ±0.64) ng/mL〕 (all P＜0.05).The rates of recurrent angina, heart failure and mortality in NSTEMI elderly patients were higher than STEMI patients during 1 year after discharge (24.3%vs.11.7%, 18.6%vs.6.7%, 25.7%vs.8.3%) (all P＜0.05).Old age (＞65 years) (HR=2.13), heart failure (HR=3.37) and Killip≥3 level at admission (HR=1.79) were risk prognostic factors for NSTEMI elderly patients and aspirin (HR=0.51) was the protective prognostic factor.Conclusions There are more diabetes, hypertension, heart failure and less persistent chest pain and lower peak creatine kinase and troponin I peak in NSTEMI elderly patients than those in the STEMI eld-erly patients.The long-term prognosis of elderly patients with NSTEMI is poor .The NSTEMI patients with old age (＞65 years), heart failure or multiple Killip≥3 level at admission are more likely to undergo poor prognosis and patients with aspirin may de-crease the poor prognosis.