性别对老年急性心肌梗死患者住院死亡的影响

目的 探讨性别对老年急性心肌梗死(AMI)患者住院病死率的影响.方法 选择在解放军总医院第六医学中心心血管内科住院的老年AMI患者605例,男性382例,女性223例,收集入选者基线资料、院内结局等临床资料,以院内死亡为终点构建多因素logistic回归模型.结果 老年AMI患者住院病死率为9.1％.女性住院心源性死亡...     

急诊经皮冠状动脉介入治疗老年急性心肌梗死并心源性休克的临床疗效及安全性评价

老年急性心肌梗死(AMI)并心源性休克的患者住院病死率高达85%以上,本研究对我院28例此类患者行急诊PCI的有关资料进行回顾性分析,旨在探讨PCI的临床疗效及安全性。1资料与方法选择2003年8月~2007年2月我院收治的AMI并心源性休克的患者28例,男性21例,女性7例,年龄61~79(65.6±3.     

急性心肌梗塞患者住院死亡率女性高于男性原因探讨

本文对181例女性和214例男性急性心肌梗塞(AMI)住院患者的资料进行分析.结果发现,住院期间女性AMI的死亡率明显高于男性(26%与14%;P<0.01).女性AMI患者具有发病年龄大、胸痛少、糖尿病较多、广泛前壁及复合部位梗塞较多、血清肌酸磷酸肌酶水平较低,心源性并发症多等特点.多因素回归分析表明,年龄、心绞痛、糖尿病、心力衰竭及休克为预示女性AMI死亡的重要因素.     

11年急性心肌梗死住院患者年龄性别特点及变化趋势

目的:分析急性心肌梗死(AMI)患者年龄、性别特点以及11年的变化趋势。方法:收集我院1994年至2004年初发急性ST段抬高心肌梗死患者资料,按照年份、不同年龄、性别进行分组并统计学分析。结果:AMI患者入院人数呈上升趋势,男性较女性增加更为明显;性别、患者平均年龄均无明显变化;男性及女性,60~74岁的患者所占比例高;45~59岁的患者男性所占比例有升高趋势,老年男性(60~74岁)比例有下降趋势。结论:心肌梗死入院患者呈上升趋势,老年人群所占比例高,男性发病有年轻化趋势。     

11年急性心肌梗死住院患年龄性别特点及变化趋势

目的：分析急性心肌梗死（AMI）患者年龄、性别特点以及11年的变化趋势.方法：收集我院1994年至2004年初发急性ST段抬高心肌梗死患者资料,按照年份、不同年龄、性别进行分组并统计学分析.结果：AMI患者入院人数呈上升趋势,男性较女性增加更为明显;性别、患者平均年龄均无明显变化;男性及女性,60～74岁的患者所占比例高;45～59岁的患者男性所占比例有升高趋势,老年男性（60～74岁）比例有下降趋势.结论：心肌梗死入院患者呈上升趋势,老年人群所占比例高,男性发病有年轻化趋势.     

不同性别老年人急性心肌梗死的临床特点

目的 :了解不同性别老年人急性心肌梗死 （AMI）的临床特点。方法 :对 1988年～ 1998年收治的 2 98（男 2 2 3,女 75 ）例老年首发 AMI进行男女对比分析。结果 :女性既往有高血压 （6 2 .7% ）、糖尿病 （34 .7% ）者高于男性（41.3% ,17.9% ） ,发病至就诊时间 >2 4h或不明确者 （6 4% ）多于男性 （2 8.3% ） ,吸烟者 （6 .7% ）少于男性（5 8.3% ）。发病后心力衰竭、心源性休克发生率、急性期病死率 （48% ,2 5 .3% ,40 % ）高于男性 （2 7.4% ,11.2 % ,2 2 .4% ）。结论 :老年女性 AMI患者严重并发症多 ,急性期病死率高。     

不同性别急性心肌梗死患者预后影响因素分析

目的 观察不同性别急性心肌梗死(AMI)患者的临床特征及预后,分析影响预后的因素.方法 入选2003-2004年我院住院的sT段抬高AMI患者904例,并随访728例,根据性别分为两组,共随访4.5年.结果 与男性相比,女性入院时合并糖尿病及高血压病者多,左室射血分数(LVEF)低,成功再灌注率低(P<0.05),住院期间病死率明显高于男性.随访期间女性坚持应用β受体阻滞剂明显少于男性,病死率及因再次AMI、心力衰竭再住院率显著高于男性(P<0.05).多因素分析显示性别是住院期间病死率的独立影响因素(OR=2.130,95%CI 0.954～4.754,P=0.045),但不是远期预后的独立影响因素.结论 多种因素导致女性AMI患者的预后差,重视女性的临床特征,积极干预危险因素才能够改善预后.     

年龄及性别对急性心肌梗死住院期病死率的影响

目的　探讨年龄及性别对急性心肌梗死 (AMI)住院期病死率的影响。　 方法 　回顾分析 2 2 0 6例AMI患者的病历资料 ,比较不同年龄及不同性别组间住院期病死率及其危险度的异同。　 结果　各年龄组的住院期病死率分别为 4.47% ,9.97% ,2 2 .0 2 %和 2 4.77%。与 <60岁组比较 ,≥ 60岁各组死亡相对危险度比数比及 95 %可信限分别为 2 .3 7,1.5 5～ 3 .61;6.0 3 ,4.2 0～ 8.67;7.0 4,4.64～ 10 .67,P均 <0 .0 1。男女组住院期病死率分别为 12 .2 %和 16.4% ,调整年龄因素的影响后 ,与男性组比较女性组死亡相对危险度比数比及 95 %可信区间为 1.3 6,1.0 0～ 1.85 ,P <0 .0 5。　 结论　老年AMI患者病情复杂 ,充血性心衰发生率高 ,住院期病死率高 ;女性住院期病死率高于男性     

2007年至2009年北京市居民急性心肌梗死住院病死率及其分布特征的研究

目的:分析2007年至2009年北京市户籍人口25岁以上人群急性心肌梗死(AMI)患者住院病死率及其分布特征。方法:研究资料来源于北京市公共卫生信息中心的北京市出院病人信息系统。AMI住院病死率指住院期间因AMI死亡的患者占所有AMI住院患者的比例。结果:2007年至2009年北京市户籍人口25岁以上人群因AMI住院者共35 335例,其中男性占68.2%。3年中AMI患者平均住院病死率为10.0%,女性为14.3%,高于男性的7.9%(P<0.001)。在二级医院住院的AMI患者的住院病死率高于三级医院者(11.4%比9.0%,P<0.001),中医医院高于西医医院者(17.5%比9.5%,P<0.001)。ST段抬高AMI患者住院病死率高于非ST段抬高患者(9.4%比8.4%,P<0.001)。住院期间未接受经皮冠状动脉介入治疗者的住院病死率,明显高于接受该治疗者(14.4%比1.9%,P<0.001)。2007年、2008年和2009年北京市AMI年龄标化住院病死率分别为10.7%、9.8%和9.4%,3年间下降了12.1%,男女两性分别下降了11.1%和10.7%。结论:目前北京市AMI住院病死率仍然较高,但近3年来逐年下降,提示北京市AMI住院期间救治水平总体提高。不同特征AMI患者的住院病死率存在差异。研究结果为进一步改善北京市AMI的住院治疗水平提供了依据。     

性别对急性心肌梗死患者住院预后的影响

目的 探讨性别是否为影响急性心肌梗死(AMI)患者住院病死率的独立危险因素.方法 对1501例男性和635例女性AMI患者进行回顾性研究,比较不同性别患者的临床特征、住院治疗和并发症发生率,并对可能影响AMI患者住院病死率的因素进行多因素回归分析.结果 与男性相比,女性患者年龄较大,高血压和糖尿病患病率较高(分别为52.1%比41.1%,35.4%比17.3%,均P<0.01),入院时血清总胆固醇>4.68 mmol/L和心功能≥KillipⅢ级者较多(分别为71.3%比55.0%,11.7%比5.1%,均P<0.01).男性患者吸烟史多于女性(69.4%比15.7%).女性患者急性期再灌注治疗率低于男性(22.2%比31.5%,P<0.01),住院期间β受体阻滞剂和调脂药的使用率也明显低于男性(分别为64.6%比71.2%,P=0.003;43.1%比48.0%,P=0.041).女性患者住院病死率高于男性(11.7%比6.3%,P<0.01).多因素回归分析显示年龄、高血压、糖尿病、高脂血症、心功能Killip分级、再灌注治疗和β受体阻滞剂的使用率为影响AMI患者住院预后的独立危险因素,性别未进入logistic回归方程.结论 女性AMI患者住院病死率明显高于男性,造成这一差异的原因在于女性患者年龄较大,伴随危险因素多,急性期再灌注治疗率和B受体阻滞剂的使用率明显低于男性.     

急性冠状动脉综合征10年间临床回顾性分析

目的了解我院急性冠状动脉综合征(ACS)住院患者在ACS治疗指南公布前后再灌注和药物治疗10年间的差异及对ACS患者住院病死率的影响。方法冠心病病房收治的950例ACS患者,分成指南公布前组(1995~1999年、A组)和指南公布后组(2000~2005年、B组)。分别对两组住院病历进行回顾性分析及比较。结果①共有950例患者入选,其中男性692例,ST段抬高心肌梗死(STEMI)患者441例,非ST段抬高心肌梗死(NSTEMI)患者162例,不稳定型心绞痛(UAP)患者347例,两组平均年龄分别为(66.4±10.3)岁和(67.2±10.5)岁。B组较A组住院时间(12.8±4.6)d比(20.5±8.5)d缩短(P均<0.001)。②近年来肝素、β受体阻滞剂、血管紧张素转化酶抑制剂(ACEI)、他汀类调脂药和氯吡格雷的使用率明显升高(P均<0.001);阿司匹林和硝酸酯类药物临床使用率较高且无明显变化(P均>0.05)。③ACS患者接受再灌注治疗方式发生改变,溶栓治疗有下降的趋势(P>0.05),而经皮冠状动脉介入治疗(PCI)明显升高(P<0.001)。住院病死率明显降低(P<0.05)。结论自ACS治疗指南公布后,住院的ACS患者肝素、β受体阻滞剂、ACEI、他汀类调脂药和氯吡格雷的使用率明显升高,溶栓治疗有下降的趋势,而PCI明显升高。住院病死率有降低趋势(P>0.05),但距指南仍有较大差距。     

The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2

BACKGROUND: Cardiogenic shock complicating acute myocardial infarction (AMI) remains the leading cause of death in patients hospitalized with AMI. Although several studies have demonstrated the importance of establishing and maintaining a patent infarct-related artery, it remains unclear as to whether intra-aortic balloon counterpulsation (IABP) provides incremental benefit to reperfusion therapy. The purpose of this study was to determine whether IABP use is associated with lower in-hospital mortality rates in patients with AMI complicated by cardiogenic shock in a large AMI registry. METHODS: We evaluated patients participating in the National Registry of Myocardial Infarction 2 who had cardiogenic shock at initial examination or in whom cardiogenic shock developed during hospitalization (n = 23,180). RESULTS: The mean age of patients in the study was 72 years, 54% were men, and the majority were white. The overall mortality rate in all patients who had cardiogenic shock or in whom cardiogenic shock developed was 70%. IABP was used in 7268 (31%) patients. IABP use was associated with a significant reduction in mortality rates in patients who received thrombolytic therapy (67% vs 49%) but was not associated with any benefit in patients treated with primary angioplasty (45% vs 47%). In a multivariate model, the use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18% (odds ratio, 0.82; 95% confidence interval, 0.72 to 0.93). CONCLUSIONS: Patients with AMI complicated by cardiogenic shock may have substantial benefit from IABP when used in combination with thrombolytic therapy.     

Aspirin and percutaneous coronary angioplasty are associated with a decline in mortality from cardiogenic shock. Results from a national Israeli survey, 1992--1998

BACKGROUND AND METHODS: Despite the significant progress in the care and outcome of patients with acute myocardial infarction (AMI), the impact of evolving therapies on the incidence and outcome of patients with cardiogenic shock complicating AMI has been questioned. We analyzed trends in the incidence, care and outcome of cardiogenic shock from four national surveys conducted during 1992--1998. RESULTS: Of the 5,351 AMI patients admitted to all coronary care units in Israel, 254 (4.7%) developed cardiogenic shock. The incidence of cardiogenic shock decreased over time (5.8, 5.1, 4.3 and 4.4% for the years 1992, 1994, 1996 and 1998, respectively, p = 0.08). Concomitantly, there was an increase in utilization of coronary angiography, urgent angioplasty and intra-aortic balloon counterpulsation. In addition, there was an increase in hospital use of aspirin, nitrates, ACE inhibitors and beta-blockers. Patients with shock were more likely to die within 7 days compared with AMI patients not having shock (65 vs. 4%; p < 0.001). During the study period, the mortality of patients with shock decreased: at 7 days (72% in 1992 to 60% in 1998; p = 0.09), at 30 days (87 to 70%, respectively; p = 0.01) and at 6 months (89 to 77%, respectively; p = 0.02). Both aspirin and angioplasty were independently associated with improved outcome after adjustment for baseline characteristics and study period. CONCLUSIONS: Although the mortality rate of cardiogenic shock complicating AMI remains high, the increased utilization of aspirin and angioplasty is associated with improved outcome.     

Comparison of primary angioplasty and conservative treatment on short- and long-term outcome in octogenarian or older patients with acute myocardial infarction

It has long been established that advanced age is not only associated with greater myocardial infarction frequency but also greater mortality and morbidity. The treatment of acute myocardial infarction (AMI) in 80 year old patients remains problematic with conflicting results; in these patients, the risks of conservative treatment are high and the risks and benefits of thrombolytic therapy are still controversial. The purpose of this study was to evaluate whether primary angioplasty can offer an important alternative method to improve short- and long-term outcomes in octogenarian or older patients who experience AMI. Between May 1986 and March 2000, 171 consecutive 80 year old patients hospitalized for AMI were not randomized to be registered and divided into a medical therapy group (group 1: an historical control group, n=11) and a primary angioplasty group (group 2, n=60). In-hospital mortality was markedly increased with advanced Killip scores (Killip 3 or 4) in both groups. Twenty-four hours after admission, group 1 patients had a significantly higher incidence of progression to higher Killip scores than did group 2 patients (P=0.006). The 30-day overall mortality of group 2 patients was significantly lower than in group 1 patients (30.0% vs 54.1%, P=0.003). Patients without cardiogenic shock treated by primary angioplasty had a significantly lower incidence of overall mortality at 30 days than patients without cardiogenic shock treated conservatively [3.1% vs 24.3%, P=0.016 (Killip 1 and 2); 18.2% vs 52.6%, P=0.044 (Killip 3)]. However, the mortality rate of cardiogenic shock was extremely high and did not differ significantly between groups I and 2 (86.1% vs 88.2%, P=0.99). The 3-year cumulative survival rate was significantly higher in group 2 than in group 1 patients (P=0.0009). In conclusion, primary angioplasty is feasible and effective, and can improve short-and long-term mortalities in octogenarian or older patients with AMI but without cardiogenic shock.     

Intra-aortic balloon pump in acute myocardial infarction and cardiogenic shock,efficiency, safety and mortality risk factors

Background and methodsCardiogenic shock remains one of the leading causes of death in patients with myocardial infarction. The Intra-aortic balloon pump (IABP) has been widely used as a treatment for acute myocardial infarction (AMI), despite recommendations against its routine use. In this paper, our aim is to analyze and share our own experience with IABP in the setting of AMI. We retrospectively reviewed the files of patients admitted with AMI and cardiogenic shock and for whom IABP was inserted between June 2016 and December 2022.Results300 patients with AMI and cardiogenic shock were admitted and benefited from IABP insertion and primary coronary revascularization. The overall mortality rate was 62.3%, the site related complication rate was 0.6%, and the overall complications rate (including site related and major bleeding) was 10.6%. There was a significantly higher mortality in the group of patients where the Left Anterior Descending artery (LAD) was the culprit lesion, in the group of patients who required dialysis, the group who had creatinine levels greater than 200 um/L compared to the group who had creatinine lower than 200 um/L, and in patients older than 70 years. Interestingly, no difference in mortality was observed between men and women, single versus multiple vessel disease, and between STEMI and non-STEMI patients.ConclusionMortality of AMI complicated by cardiogenic shock and treated by IABP remains high. However, IABP usage is associated with a low complication rate. Better selection criteria for IABP usage versus other more powerful mechanical circulatory support devices in such patients might improve the outcome for the patient.     

Outcomes and early revascularization for patients > or = 65 years of age with cardiogenic shock

Hospital survival of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock has improved during recent years. It is unclear whether this mortality benefit also applies to elderly patients with cardiogenic shock. Elderly residents (age > or = 65 years) of the Worcester, Massachusetts metropolitan area (1990 census population = 437,000) hospitalized with confirmed AMI and cardiogenic shock in all metropolitan Worcester, Massachusetts hospitals between 1986 and 1997 constituted the sample of interest. We examined the use of coronary reperfusion strategies, adjunctive therapy, and hospital mortality in a cohort of 166 cardiogenic patients treated early in the reperfusion era (1986 to 1991) compared with 144 patients with AMI treated approximately 1 decade later (1993 to 1997). There was a significant increase in the use of an early revascularization strategy over time (2% vs 16%, p <0.001). Marked increases in use of antiplatelet therapy, beta blockers, and angiotensin-converting enzyme inhibitors were also observed over the decade-long experience. In-hospital case fatality declined significantly over time, from 80% (1986 to 1991) to 69% (1993 to 1997) in elderly patients who developed cardiogenic shock (p = 0.03). After adjusting for differences in potentially confounding prognostic characteristics between patients hospitalized in the 2 study periods, an even more pronounced reduction in hospital mortality (42%) was observed for the most recently hospitalized cohort. The most powerful predictor of in-hospital survival was use of an early revascularization approach to treatment. Thus, hospital mortality has declined for patients > or = 65 years of age with AMI complicated by cardiogenic shock, and this decline has occurred in the setting of broader use of early revascularization and adjunctive medical therapy for this high-risk population.     

Leukocytosis and adverse hospital outcomes after acute myocardial infarction

An elevated white blood cell (WBC) count at the time of hospital presentation is associated with increased mortality after acute myocardial infarction (AMI). The association between WBC count and the development of clinically significant complications of AMI and death during hospitalization for AMI is, however, less clear. The objectives of this observational study were to examine the association between baseline WBC count, the development of heart failure, cardiogenic shock, and death during hospitalization for AMI from a more generalizable community-wide perspective. The study sample consisted of adult residents of all ages from the Worcester, Massachusetts, metropolitan area (1990 census estimate 437,000) hospitalized with confirmed AMI at all greater Worcester medical centers. The study population consisted of 3,796 men and 2,734 women of all ages hospitalized with validated AMI, in 12 annual periods between 1986 and 1999, aggregated into quintiles based on WBC count obtained at the time of hospital admission. In multivariable-adjusted regression analyses controlling for potentially confounding demographic and clinical factors, patients in the uppermost quintiles of WBC count were at increased risk for heart failure (odds ratio [OR] 2.77, 95% confidence interval [CI] 2.33 to 3.31), cardiogenic shock (OR 2.82, 95% CI 2.05 to 3.87), and hospital death (OR 2.14, 95% CI 1.66 to 2.76). The results of our large observational study suggest that the peripheral total leukocyte count is strongly associated with the development of heart failure, cardiogenic shock, and death during hospitalization for AMI. These findings suggest that the WBC count should be considered an important prognostic factor associated with adverse hospital outcomes in patients with AMI.     

肾小球滤过率对老年急性心肌梗死近期预后的影响

目的探讨入院时估测肾小球滤过率(eGFR)对老年急性心肌梗死(AMI)住院患者近期(30d内)预后的影响。方法入选2001年1月至2007年12月因AMI收住的327例老年患者为研究对象。根据入院时eGFR水平ml/(min·1.73m2)分为4组:肾功能正常组(eGFR≥80),轻度肾功能不全组(eGFR60～79),中度肾功能不全组(eGFR30～59)及重度肾功能不全组(eGFR30)。统计分析30d心源性病死和心脏并发症(心源性休克、心力衰竭或室速/室颤)的发生率及影响近期预后的相关因素。结果 4组患者30d病死率分别为3.7%、12.1%、23.6%和28.6%,心脏并发症的发生率分别为15.4%、37.4%、59.7%和64.3%(均P0.01)。单因素分析显示,年龄,糖尿病、脑卒中病史,贫血,首发症状呼吸困难,并发心源性休克、心力衰竭或室速/室颤及入院时eGFR减低是30d病死率的危险因素(均P0.05)。多因素分析显示,入院时eGFR减低、年龄、伴糖尿病者30d病死率均增高,比值比(OR)分别为1.6095%可信区间(CI)1.08～2.36、1.07(95%CI1.02～1.13)和3.34(95%CI1.34～8.34);住院期间发生心源性休克、心力衰竭及室速/室颤者同样也增加30d病死率,OR分别为16.18(95%CI4.68～55.97)、5.33(95%CI2.26～12.56)和3.99(95%CI1.29～12.33)。结论老年AMI患者入院时eGFR降低是急性期预后的独立预测因子。     

Efficacy of invasive strategy for the management of acute myocardial infarction complicated by cardiogenic shock

This retrospective study evaluates the influence of an invasive strategy of urgent coronary revascularization on the in-hospital mortality of patients with acute myocardial infarction (AMI) complicated early by cardiogenic shock. Among 1,981 patients with AMI admitted to our institution from 1994 to 1997, 162 patients (8.2%) developed cardiogenic shock unrelated to mechanical complications. The strategy of management was considered invasive if an urgent coronary angiography was indicated within 24 hours of symptom onset. Every other strategy was considered conservative. Fifty-seven patients who developed the shock late or after a revascularization procedure, or who died on admission, were excluded. The strategy was invasive in 73 patients (70%). Five of them died before angiography could be performed and 65 underwent angioplasty (success rate 72%). By univariate analysis the invasive strategy was associated with a lower mortality than conservative strategy (71% vs 91%, p = 0.03), but this association disappeared after adjustment for baseline characteristics. Older age, nonsmoking, and previous ischemic heart disease were independent predictors of mortality. In conclusion, we have failed to demonstrate that a strategy of urgent coronary revascularization within 24 hours of symptom onset for patients with AMI complicated by cardiogenic shock is independently associated with a lower in-hospital mortality. This strategy was limited by the high mortality within 1 hour of admission in patients with cardiogenic shock, the modest success rate of angioplasty in this setting, and the powerful influence of some adverse baseline characteristics on prognosis.     

Efficacy of percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction complicated by cardiogenic shock.

Cardiogenic shock still remains a highly lethal complication of acute myocardial infarction (AMI). This study reviews our hospital experience in treating AMI complicated by cardiogenic shock to evaluate whether coronary angioplasty improves survival or not. We have treated 523 AMI patients from 1985 to 1990, and among these, 26 patients with AMI complicated by cardiogenic shock who underwent percutaneous transluminal coronary angioplasty (PTCA) compose the study group. In 16 patients, PTCA was successful (Groups S) and in 10 patients, unsuccessful (Group F). There were no statistical differences between the Groups with respect to clinical background, intraaortic balloon counterpulsation (IABP) or emergency coronary bypass graft surgery. Before PTCA, hemodynamic variables including cardiac index, pulmonary capillary wedge pressure and systolic blood pressure were similar in the 2 groups. After PTCA, cardiac index in Group S patients was better than in Group F patients (2.18 +/- 0.61 versus 1.62 +/- 0.65, p less than 0.05). Thirty day and 1 year survivals were also better in Group S than in Group F (30 day survival: Group S 56.2%, Group F 10%, 1 year survival: Group S 31.2%, Group F 0%, p less than 0.05). Multivariate analysis showed that age under 75 years old, systolic blood pressure over 90 mmHg after PTCA and successful PTCA were independent predictors of 30 day survival (p less than 0.05). It was suggested that PTCA was an effective procedure to reduce mortality in patients with cardiogenic shock.