Objective: To investigate the risk factors of in- hospital mortality in elderly patients with a-cute myocardial infarction ( AMI ) by analysing the clinical and angiographic characteristics. Method:420 patients with AMI, in - hospital mortality were compared in patients aged < 75 years with those aged≥5 75 years. We then collected data concerning cardiac risk factors , comorbidities, post-AMI complications, he-modynamin measurements and angiographic parameters. Result: There were 347 patients aged <75 years ( 82.6% ),and 73 patients aged ≥75 years( 17. 4% ). Older patients were smaller and more likely to be women and had a higher Killip class at presentation, Cardiac risk fators and comorbidities more prevalent a-mong older patients. Older patients had more diseased vessels, lower LV ejection fration, higher LV end_di-astolic pressure, but fewer vessels with TIMI 0 flow. Older patients were equally likely to undergo percutaneous intervention (88% vs 91% P = NS ),but had a lower rate of procedural success! 93% vs 96% P + 0. 047 ). Overall, final stenosis after percutaneous intervention was higher in the older patients( 21 ±25% vs 18 ±21% ,P = 0. 02 )and the rate of TIMI 3 flow was lower( 85% vs 92% ,P<0. 01 ). Conclusion: The strongest predictors of death were aged ≥575 years, lower final TIMI flow, higher Killip class,need for an intra-aortic balloon pump .%目的:通过对临床及造影资料的详细分析,研究影响老年AMI患者住院期间死亡的危险因素.方法:420名急性心梗患者,比较年龄＜75岁与≥75岁两组的主要死亡率,收集患者的临床资料(包括心血管危因素、合并症、心梗并发症及血液动力学指标)及冠脉造影资料.结果:年龄＜75岁者347名(82.6%),≥75岁者73名(17.4%),老年组患者较少,女性较多,Killip分级较高,老年组心血管危险因素及合并症较多,血管病变的支数多,LVEF更低、左室舒末压更高,但TIMI血流0级者少,两组行PCI的比率相近(88% vs 91% P=NS),但老年组成功率低(93% vs 96% P+0.047).老年组残余狭窄高(21±25% vs 18±21%,P=0.02),达到TIMI3级血流的低(85% vs 92%,P<0.01).结论:影响住院死亡率最有力的预测因子是年龄≥75岁、最终TIMI分级低、入院时左室射血分数、需IABP支持等因素.
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