Objective To analyze the clinical characteristics and risk factors of in-hospital death in elderly patients with acute myocardial infarction (AMI). Methods AMI patients (n=476, male 338, female 138 and aged from 61 to 85) were chosen from Jan. 2008 to Jan. 2014, and then divided into survival group (n=377) and death group (n=99) according to the prognosis. The levels of cardiac troponin T (cTnT), creatine kinase MB (CK-MB), B-type brain natriuretic peptide (BNP), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C) and creatinine (Cr) were detected, and glomerular filtration rate (GFR) was calculated. The risk factors of in-hospital death were analyzed by using Logistic regression analysis. Results The percentages of cases with past medical history, smoking, ventricular tachycardia or ventricular fibrillation, higher levels of CK-MB, cTnT, HDL-C and BNP, and percentages of cases with cardiac Killip gradeⅢand Killip gradeⅣincreased, and GFR and LVEF decreased in death group compared with survival group (all P<0.05). Age (OR=1.074, 95%CI:1.038~1.121), diabetes (OR=1.332, 95%CI:1.528~8.034), coronary heart disease (old myocardial infarction, OR=5.627, 95%CI:1.807~16.840), GFR (OR=1.442, 95%CI:1.021~2.107), cardiac Killip grading (OR=3.432, 95%CI:1.074~82.455), ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation, OR=3.835, 95%CI:1.317~9.812), cTnT (OR=1.010, 95%CI:1.002~1.011) and LVEF (OR=0.860, 95%CI:0.818~1.923) were independent risk factors of in-hospital death (all P<0.01). Conclusion Advanced age, complicating diabetes and old myocardial infarction, decreased GFR, increased cTnT, higher cardiac Killip grade, lower LVEF and ventricular arrhythmia all are independent risk factors of in-hospital death in elderly patients with AMI.%目的：分析老年急性心肌梗死（AMI）患者的临床特点以及住院死亡的危险因素。方法回顾性入选自2008年1月~2014年1月在北京军区总医院住院治疗的AMI患者476例，其中男性338例，女性138例，年龄61~85岁。依据预后分为：存活组（377例）和死亡组（99例）。比较两组入院后24 h内肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK-MB）、B型脑钠肽（BNP）总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）和肌酐水平，计算肾小球滤过率并分析两组患者的心功能Killip分级及左室射血分数（LVEF）。Logistic回归分析老年AMI患者住院死亡的危险因素。结果与存活组比较，死亡组的既往病史比例、吸烟比例、室速或室颤比例、CK-MB、cTnT、HDL-C、BNP以及心功能KillipⅢ级和Ⅳ级比例升高，肾小球滤过率、LVEF下降，差异均有统计学意义（P均＜0.05）。年龄（OR=1.074，95%CI：1.038~1.121）、糖尿病（OR=1.332，95%CI：1.528~8.034）、冠心病（陈旧性心肌梗死）（OR=5.627，95%CI：1.807~16.840）、肾小球滤过率（OR=1.442，95%CI：1.021~2.107），心功能Killip分级（OR=3.432，95%CI：1.074~82.455）、室性心律失常（室速或室颤）（OR=3.835，95%CI：1.317~9.812）、cTnT（OR=1.010，95%CI：1.002~1.011）、LVEF（OR=0.860，95%CI：0.818~1.923）是住院死亡的独立危险因素（P均＜0.01）。结论高龄、合并糖尿病和陈旧性心肌梗死、肾小球滤过率降低、cTnT升高、Killip分级高、LVEF降低、室性心律失常是老年急性AMI患者住院死亡的独立危险因素。
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