关键词:

急性心肌梗死, 老年, 临床特征, 病死率, 危险因素

Abstract:

Objective　To investigate the clinical characteristics and risk factors for all-cause mortality in elderly patients with acute myocardial infarction (AMI). Methods　This study is a retrospective cohort study. A total of 1 554 patients with AMI who were hospitalized in the First Affiliated Hospital of Xi 'an Medical University from January 2020 to September 2024 were selected. Among them, 583 patients aged ≥65 years were in the elderly group, and 971 patients aged <65 years were in the non-elderly group. Baseline data including age, sex, medical history, and smoking status were collected for all study subjects. Clinical symptoms, heart function assessed by Killip classification, whether the patient underwent percutaneous coronary intervention (PCI), intraoperative and postoperative complications, medications during hospitalization, length of stay, and in-hospital mortality were also recorded. Logistic regression analysis was used to identify risk factors for all-cause mortality in AMI patients. Statistical analysis was performed using χ², t tests, and Mann-Whitney U tests. Results　Among the 583 patients in the elderly group, there were 393 males (67.41%) with an average age of (74.31±7.39) years. In the non-elderly group of 971 patients, there were 867 males (89.29%) with an average age of (51.46±9.17) years. The proportions of males, smokers, obese patients, those with a family history of early coronary heart disease, and patients with hyperlipidemia, as well as pulse, heart rate, and diastolic pressure in the elderly group, were all lower than those in the non-elderly group (all P<0.001). The proportions of patients with a history of hypertension, PCI, chronic obstructive pulmonary disease (COPD), and cerebrovascular disease in the elderly group were higher than in the non-elderly group. Laboratory tests showed that the elderly group had lower levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-sensitivity cardiac troponin, and left ventricular ejection fraction compared to the non-elderly group (all P<0.05), while high-density lipoprotein cholesterol (HDL-C) and NT-proBNP levels were higher in the elderly group (both P<0.001). The main symptoms in both groups were chest tightness or chest pain. The revascularization rate in the elderly group was lower than in the non-elderly group [93.32% (544/583) vs. 99.18% (963/971)], with a longer length of hospitalization [10 (7, 12) days vs. 9 (7, 11) days] and a higher in-hospital mortality rate [6.87% (40/583) vs. 1.13% (11/971)], with all differences being statistically significant (all P<0.05). Univariate and multivariate logistic regression analyses revealed that age [odds ratio (OR)=1.040, 95% confidence interval (CI) 1.009-1.073, P=0.011], Killip class Ⅳ heart function (OR=2.533, 95%CI 1.053-6.095, P=0.038), no revascularization measures (OR=0.250, 95%CI 0.090-0.695, P=0.008), heart failure (OR=3.684, 95%CI 1.771-7.662, P<0.001), shock (OR=4.005, 95%CI 1.744-9.196, P=0.001), and mechanical complications (OR=46.340, 95%CI 6.809-315.385, P<0.001) were identified as independent risk factors for mortality in patients with acute myocardial infarction. Conclusions　Elderly patients with acute myocardial infarction have low reperfusion therapy rate and high mortality rate. Shock, heart failure, age, no revascularization measures, and cardiac function Killip class Ⅳ were independent risk factors for all-cause mortality in patients with acute myocardial infarction.

Key words:

Acute myocardial infarction, Old age, Clinical features, Mortality rate, Risk factors