Analysis of hospitalized death related factors in elderly patients with non-ST-segment elevation myocardial infarction

目的 评价老年非ST段抬高心肌梗死(NSTEMI)患者住院死亡的相关因素. 方法 选择年龄≥65岁的老年NSTEMI住院患者302例,其中死亡32例(死亡组),存活组270例.回顾性分析其临床资料,评价院内死亡相关因素. 结果 两组性别、既住高血压、糖尿病、高脂血症,吸烟、心绞痛、心肌梗死、脑血管病、已知肾功能不全史比较,差异无统计学意义(均为P＞0.05).死亡组并存≥3种慢性疾病、入院心率＞100次/min、入院心功能高Killip分级(Ⅲ、Ⅳ级)、入院血白细胞＞10×109L高于存活组,差异均有统计学意义(P＜0.05);两组人院24 h内空腹血糖水平及入院血清肌酐水平比较,差异无统计学意义(P＞0.05),但结合估算肾小球滤过率(eGFR)重新评估肾功能状态后,死亡组肾功能不全高于存活组(P＜0.01);死亡组并存肺部感染者高于存活组(P＜0.01).多因素Logistic分析结果 显示,入院时心功能高Killip分级、eGFR评估的肾功能不全、并存肺部感染是老年NSTEMI患者住院期间死亡的独立预测因素. 结论 并存多种慢性病是老年NSTEMI患者死亡的原因之一;eGFR评估肾功能不全、并存肺部感染是老年NSTEMI患者死亡的独立预测因素.Objective To analyze hospitalized death related factors in elderly patients with nonST-segment elevation myocardial infarction (NSTEMI). Methods Three hundred and two patients (≥65 years old) with NSTEMI were included. Thirty-two patients of them died in hospital (death group). Their clinical data were retrospectively analyzed and correlated factors for in-hospital death were evaluated. Results Compared with survival group, patients in death group were more likely to have 3 or more chronic diseases,heart function killip grades Ⅲ- Ⅳ, heart rate＞ 100/min and peripheral blood WBC count＞10X 10＜'9＞/L on admission (all P＜:0.05). There was no significant difference in fasting plasma glucose level and serum creatinine on admission between the two groups (both P:＞0.05). But after glomerular filtration rate(eGFR) were estimated by the modified abbreviated MDRD equations based on the Chinese CKD patients, patients in death group were more likely to be with renal dysfunction and pulmonary infection (both P＜0.01 ). Multiple logistic regression analysis showed that heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR, pulmonary infection on admission were the independent predictors for in-hospital death in elderly patients with NSTEMI. Conclusions Coexistence of 3 or more chronic diseases is a related factor of death and heart function killip grades Ⅲ-Ⅳ, renal dysfunction evaluated by eGFR and pulmonary infection are the independent predictors for in-hospital death in elderly patients with NSTEMI.国家科技支撑计划中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)010739-7422