危重急性心肌梗死患者院内死亡的预测因素

摘要

Objective: To observe the clinical features of patients with severe acute myocardial infarction (AMI) and explore the correlation factors associated with in-hospital death of the severe AMI, and then construct and analyze the predicting model. Methods: One hundred and thirty-two patients with AMI of Killip's class Ⅲ and Ⅳwere selected in this study.The clinical data of all those patients were collected. Univariate and multivariate analysis were performed to evaluate the correlation factors associated with in-hospital death of the severe AMI.And the logistic regression model was constructed. The model with the ROC curves was analyzed and used in clinical practice, Results: In 132 patients, there were 64 (48.48％) patients discharged (impdroved group), in which 60 (93.8％) with a non-ST segment elevation myocardial infarction. Compared with the improved group, there were 68 patients in-hospital death (51.52％), in which 36 (52.9％) patients with broad front wall myocardial infarction and 58 (85.3％) patients with heart failure or cardiogenic shock. Compared with the improved group, there were higher proportions of arrhythmia and broad front wall myocardial infarction in death group. There were significantly lower levels of glomerular filtrate rate (eGFR) and systolic blood pressure (SBP), but significantly higher values of white blood cell (WBC) count, blood urea nitrogen (BUN), serum creatinine (CREA), the MB fraction of creatine kinase (CK-MB) and cardiac troponin I (CTnI), in death group than those in control group (P ＜ 0.05 or P ＜ 0.01). Multifactorial logistic regression analysis showed that anterior and lateral myocardial infarction, arrhythmias and blood urea nitrogen were independent risk factors of in-hospital death in AMI patients. The AUC value generated by ROC curves for the logistic regression equation was 0.945. At a chosen false positive fiaction of 10％, diagnostic value was 0.462. Conclusion: Severe acute myocardial infarction had a high in-hospital mortality rate. There was a higher predictive value in model of logistic equation in clinical practice.%目的:观察危重急性心肌梗死(AMI)患者的临床特点,探讨其院内死亡的危险因素并建立和分析运用预测模型.方法:选取临床资料完备的Killip'sⅢ～Ⅳ级AMI的住院患者132例,记录患者的相关临床资料.应用Logistic 回归评估危重AMI患者院内死亡的危险因素并建立预测模型,用ROC曲线分析该模型并可将其用于临床实践.结果:132例患者中,好转出院者(好转组)64例(48.48%),其中非ST段抬高型心肌梗死60例(93.8%).院内死亡(死亡组)68例(51.52%),其中广泛前(侧)壁心肌梗死36例(52.9%),死因为心衰或心源性休克者58例(85.3%).与好转组相比,死亡组中心律失常和广泛前(侧)壁心肌梗死所占比例明显升高,死亡组人院时的eGFR和SBP偏低,WBC、BUN、CREA、CK-MB、CTnI偏高,差异有统计学意义(P<0.05或P<0.01).多因素分析表明广泛前(侧)壁AMI,心律失常和BUN升高是危重AMI患者院内死亡的危险因素.所得Logistic回归方程的ROC曲线下面积为0.945,取假阳性率为10%后求得诊断点为0.462.结论:危重AMI患者院内病死率高,所得Logistic方程的预测及临床应用价值较高.