危重急性心肌梗死患者院内死亡的预测因素

[摘要] 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：选取我院心脏科2006年4月—2010年4月住院的killp’s Ⅲ～Ⅳ级AMI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，院内死亡者68例（51.52%），其中死因为心衰或心源性休克者58例，好转出院者64例（48.48%）。死亡组中广泛前(侧)壁心肌梗死占44.1%，好转组中非ST段抬高型心肌梗死占93.8%。 与好转组相比，死亡组中心源性休克、心律失常所占比例明显升高，死亡组入院时的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是危重AMI患者院内死亡的独立危险因素。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高。

Predictors of In-Hospital Death in Patients with Severe Acute Myocardial Infarction

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 presenting with acute myocardial infarction of Killip class Ⅲ and Ⅳ were enrolled in The Second Hospital of Tianjin Medical University between April 2006 and April 2010. 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 logistic regression model was constructed. Analyze the model with the ROC curves. Results: The total mortality of 132 patients was 51.5 %. Compared with the improved group, the death group was associated with a higher proportion of cardiogenic shock and arrhythmias. Glomerular filtrate rate (eGFR), systolic blood pressure (SBP) were significantly lower in the death group than in the control group, While blood urea nitrogen (BUN) , serum creatinine (CREA), white blood cell (WBC) count, the MB fraction of creatine kinase (CK-MB) and cardiac troponin I (CTnI) were higher in the death group than in the improved group. Multi-factorial logistic regression analysis showed that anterior and lateral myocardial infarction , arrhythmias and blood urea nitrogen might be independent risk factors of in-hospital death. The AUC values generated by the ROC curves for the logistic regression equation was 0.945. Conclusion: Severe Acute Myocardial Infarction had high mortality rate. and the predictive value of the model is high.