非ST段抬高心肌梗死预后的影响因素分析

目的分析影响非ST段抬高心肌梗死(NSTEMI)预后的相关因素及有效的治疗策略。方法收集2001年1月～2010年1月资料完整的NSTEMI患者206例,随访≥6个月,以随访6个月和2年的预后分别为近期和远期预后,记录心血管事件,包括主要终点事件(心源性死亡)和联合终点事件心源性死亡和(或)非致死性心肌梗死],应用Cox生存模型对影响预后的多因素进行分析。结果 1 42例完成6个月随访,共发生心血管事件20例,其中心源性死亡1 6例(11.27%)、非致死性心肌梗死4例(2.82%);93例完成2年随访,共发生心血管事件20例,其中心源性死亡15例(16.1 3%)、非致死性心肌梗死5例(5.38%)。影响患者近期预后的因素为年龄、心力衰竭、肾功能不全、阿司匹林,影响患者远期预后的因素为年龄、心力衰竭、肾功能不全、阿司匹林、早期PCI。结论 NSTEMI患者预后不佳,年龄、心力衰竭、肾功能不全是最重要的危险因素,而阿司匹林是重要的保护因素,早期PCI可显著改善患者的远期预后。

Investigation of factors influencing prognosis of patients with non-ST-segment elevation myocardial infarction

Objective To evaluate the prognostic factors and the effective treatment strateges in patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods 206 patients with NSTEMI were selected from the Department of Cardiology of our hospital during January 2001 to January 2010.The patients were followed up for 6 months to 2 years.The primary end point was cardiac death and the combined end point was a composite of cardiac death and nonfatal myocardial infarction.Cox regression model was used to analyze the association between risk factors and combined end points.Results 142 patients finished the 6-months follow up,20 cardiovascular events occurred,including 16(11.27%) cardiac death and 4(2.82%) myocardial infarction. 93 patients finished the 2-years follow up,there were also 20 cardiovascular events,including 15 cardiac death and 5 myocardial infarction.The most important baseline determinants of shortterm outcome were age,heart failure,renal insufficiency and aspirin;the most important baseline determinants of long-term outcomes were age,heart failure,renal insufficiency,aspirin and early PCI.Determinants of mortality were also predictors of death or myocardial infarction.Conclusion Patients with NSTEMI have poor outcomes.Age,heart failure and renal insufficiency are most important risk factors;while aspirin is an important protective factor,early PCI can significantly improve long-term prognosis of patients.