东莞市住院的本地与外来人员急性ST段抬高型心肌梗死特征及预后情况分析

目的比较住院的东莞市外来急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的临床特征及预后与本地患者的差异。方法回顾性收集东莞市人民医院病历库2015年1月至2018年12月连续住院的急性STEMI患者临床资料,比较非东莞籍和东莞籍患者的临床特征。主要终点事件为30 d复合终点事件,包含全因死亡、再发非致死性心肌梗死、脑梗死、心力衰竭、恶性心律失常以及非计划再住院治疗;次要终点为住院时间延长。结果共纳入848例连续非重复的新发STEMI患者,年龄56(48~66)岁,男性占84.3%,住院时间为7.0(6.0~9.0)d。共收集到30 d复合终点事件51例,住院时间延长患者172例。与东莞籍患者比较,非东莞籍STEMI患者男性比例更高(88.8%vs.79.8%,P<0.001),多数来自农村(73.3%vs.54.4%,P<0.001),发病年龄小[51(45~58)岁vs.62(54~72)岁,P<0.001],接受急诊再灌注治疗比例低(68.6%vs.82.2%,P<0.001),差异有统计学意义;但其30 d复合终点事件与东莞籍患者相似,差异无统计学意义(4.7%vs.7.4%;P=0.101)。较高Killips分级和未行再灌注治疗是30 d复合终点事件的预测因子。年龄增加、糖尿病史、较高Killips分级、接受再灌注治疗和有医疗保险支持是住院时间延长的预测因素。结论东莞市外来人员急性STEMI患者以男性农民工居多,发病年龄更小,接受急诊再灌注治疗比例更低,近期预后与东莞籍患者相似。

Characteristics and prognosis of migrant and aboriginal hospitalized patients with acute ST-elevation myocardial infarction in Dongguan City

Objectives To investigate the clinical characteristics and prognosis of migrant and aboriginal hospitalizedpatients with acute ST-elevation myocardial infarction(STEMI)in Dongguan City.MethodsWe retrospectivelyretrieved consecutive hospitalized patients due to acute STEMI between January 2015 and December 2018 from theElectronic Medical Record library in Dongguan People’s Hospital.Patients were divided into two groups according tomigrants or not.The primary endpoint was 30-day composite endpoint events(CEEs),including all-cause mortality,non-fatal myocardial infarction,stroke,heart failure,malignant arrhythmia and unplanned rehospitalization.Thesecondary endpoint was prolonged hospital stay.ResultsA total of 848 patients were enrolled,aged 56(48-66)yearsold,and of whom 84.3%were males,and the median hospital stay was 7.0(6.0-9.0)days.There were 172 patientswith prolonged hospital stay,and 51 CEEs were observed during 30-day follow-up.Compared with aboriginal patients,migrants were higher in the proportion of males(88.8%vs.79.8%,P<0.001),from rural areas(73.3%vs.54.4%,P<0.001),younger[51(45-58)years old vs.62(54-72)years old,P<0.001],and lower in the proportion of receiving re-perfusion treatment(68.6%vs.82.2%,P<0.001).There was no significant difference in 30-day CEEs between mi-grants and aboriginal patients(4.7%vs.7.4%,P=0.101).Higher Killip class and absence of reperfusion were independent predictors of 30-day CEEs.Aged,history of diabetes mellitus,higher Killip class,reperfusion treatment andmedicare supports were independent predictors of prolonged hospital stay.ConclusionsThe majority of migrant pa-tients with acute STEMI in Dongguan city were males and from rural areas.They were younger and less to receive reper-fusion treatment.The short-term prognosis was similar between migrants and aboriginal patients.