老年人急性心肌梗死的临床特征分析

目的　探讨老年人急性心肌梗死 (AMI)的临床特点。方法　对住院的 AMI患者的临床资料进行统计 ,分析年龄≥ 6 0岁的老年 AMI患者 (老年组 )及年龄 <6 0岁 (非老年组 )患者的临床特点。结果　本研究包括 2 5 8例老年AMI患者 (平均年龄 6 8.5± 6 .6岁 )及 117例非老年 AMI患者 (平均年龄 5 1.2± 6 .8岁 )。与非老年患者比较 ,老年AMI患者更多患有心绞痛或陈旧性心肌梗死 (7.8%与 18.2 % ,P <0 .0 2 )及高血压病 (43.6 %与 5 8.1% ,P <0 .0 1)。表现为无 Q波心肌梗死 (NQMI)的老年患者明显高于非老年组 (13.1%与 6 .0 % ,P<0 .0 5 ) ,肌酸激酶 (CK)峰值在老年组则显著低于非老年组 (1198.7± 132 2 .1U /L与 15 70 .4± 15 0 7.0 U /L ,P<0 .0 2 )。老年组较非老年组中有更多的患者伴有心力衰竭 (8.5 %与 2 .6 % ,P<0 .0 2 ) ,心房颤动 (14 .7%与 5 .1% ,P<0 .0 1)及右束支传导阻滞 (RBBB) (8.9%及 0 % ,P<0 .0 0 1) ,死亡率也显著增高 (13.5 %与 5 .1% ,P<0 .0 2 ) ,但老年患者却较少接受静脉溶栓治疗 (2 0 .1%及 4 1.9% ,P<0 .0 0 1)及择期经皮腔内冠状动脉成形术 (PTCA) (13.5 %与 33.3% ,P<0 .0 0 1)。结论　本研究提示老年 AMI患者较非老年患者更多表现为 NQMI,更多伴有心房颤动、心力衰竭及 RBBB等

The clinical characteristics of acute myocardial infarction in elderly patients

Objective To investigate the clinical characteristics of acute myocardial infarction in elderly patients. Methods The clinical characteristics of acute myocardial infarction in elderly (age≥60 years, elderly group) and non elderly patients(non elderly group) were studied retrospectively. Results 258 elderly patients (mean age 68.5±6.6) and 117 non elderly patients(mean age 51.2±6.8) were included in this study. The elderly AMI patients compared with non elderly group were more often presented as non Q myocardial infarction (NQMI) (13.1% vs 6.0%, P <0.05), and had history of previous angina pectoris or old myocardial infarction(18.2% vs. 7.8%, P <0.02) and hypertension(58.1% vs 43.6%, P <0.01). The averaged CK peaks were significantly lower in the elderly group than that of non elderly (1 198.7±1 322.1 U/L vs. 1 570.4±1 507.0U/L, P <0.02).The elderly patients were also more often complicated with heart failure (8.5% vs 2.6%, P <0.02), atrial fibrillation (14.7% vs 5.1%, P <0.01) and right bundle branch block (8.9% vs 0%, P <0.001).The in hospital mortality in the elderly group was significantly higher than in that of non elderly patients(13.5% vs 5.1%, P <0.02),but less patients had intravenous thrombolysis therapy (20.1% vs 41.9%, P <0.001) and selective percutaneous transluminal angioplasty (PTCA) (13.5% vs 33.3%, P <0.001).Conclusion The elderly AMI patients were more often presented as NQMI, complicated with atrial fibrillation, heart failure or RBBB and had higher in hospital mortality, but they had less chance to be treated with intravenous thrombolysis therapy and selective PTCA.