75岁以上急性心肌梗死患者的临床特征

目的:了解执行《心肌梗死全球统一定义》后,75岁以上高龄急性心肌梗死(acute myocar-dial infarction,AMI)患者的临床特征。方法:入选2009年7月至2011年8月在我院心内科冠心病监护病房住院的老年AMI患者563例,年龄≥75岁的患者作为高龄组,65～74岁的患者作为对照组(非高龄老年组)。回顾性分析两组患者的一般情况、吸烟、心脑血管疾病史、主要症状与体征、生化、心电图、超声心动图结果、主要治疗、合并疾病、并发症、院内不良事件等临床资料和随访情况,并进行比较。结果:与对照组比较,高龄组女性、既往有心绞痛和心肌梗死及脑血管病史、无典型胸痛症状、非ST段抬高心肌梗死(NSTEMI)的比例较高(P<0.05);院前延误时间较长(P<0.01);而舒张压、低密度脂蛋白胆固醇、肌酸激酶同工酶(CK-MB)峰值、左心室射血分数较低;接受血运重建、RAS抑制剂治疗的比例较低(P<0.05),合并疾病、并发症、院内不良事件发生率和病死率更高(P<0.05)。在高龄组中,男性比女性吸烟率较高(P<0.05),接受血运重建率也有增高的趋势(P=0.0682)。随访发现两组患者院外坚持服用阿司匹林、β受体阻滞剂、β受体阻滞剂、肾素血管紧张素抑制剂(RAS)、他汀类调脂药物的百分率均较住院时显著下降(P<0.05),而高龄组比对照组坚持服药率更低(P<0.05);高龄组较对照组院外病死率、再住院率更高(P<0.05)。结论:与非高龄老年组比较,高龄组AMI患者一般情况较差,合并疾病和并发症较多;女性、NSTEMI的比例较高;症状不典型、就诊较晚;较少接受充分治疗,预后较差。

Clinical characteristics of elderly patients with acute myocardial infarction in aged greater than 75 years Chinese

Objective:To summarize the clinical characteristics of elderly patients with acute myocardial infarction in aged greater than 75 years,after performed universal definition of myocardial infarction.Methods:This study enrolled 563 cases of confirmed AMI hospitalized to CCU of the hospital between July 2009 and August 2011.They were divided into two age groups according to their ages,senior group including those over 75 years of age(n=296),and the control group aged from 65 to 74 years(n=267).The patients’ data,including clinical characteristics(general condition,age,smoking,laboratory examinations,and complications),treatments,in-hospital complications and mortality were recorded and compared between the two groups.The patients of them were followed up.Results:Compared with control group,there were more female patients and more patients without chest pain in the senior elderly group(P<0.05);they had a long delay between the onset of chest pain and the treatment(P<0.01);their serum CK-MB concentration and LDL-C was lower than that of control group(P<0.05);they had poorer heart function and more comorbiditics(P<0.05).Smoking were less observed in the senior group(P<0.05).There were less patients in the senior elderly group who were performed revascularization therapy and βblacker administration(P<0.05).Patients in the senior group experienced more adverse events,including heart failure and infection and bleeding and in-hospital mortality than control group(P<0.01).The rate of smoking was higher(P<0.05) and the rate of performed revascularization therapy was similar higher(P=0.0682) in men than women in the senior group.548(287 senior) patients were followed up.The use of aspirin and β blockers and rennin angiotensin system inhibitors and statins was lower during follow-up compared with them in-hospital in the two groups(P<0.05),and the use of the drugs in the senior group was lower than that in the control group(P<0.05).Compared with control group,the rate of readmission for heart failure and the rate of mortality was higher in senior group(P<0.05).Conclusion:Senior elderly patients with AMI have poor general conditaion,more comorbidity,less revascularization therapy and effective drug therapy,and higher adverse events and mortality.