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

摘要：

目的　探究老年急性心肌梗死（AMI）患者临床特征和全因死亡危险因素的相关性。方法　本文为回顾性队列研究。选取2020年1月至2024年9月在西安医学院第一附属医院住院治疗的AMI患者1 554例，其中年龄≥65岁的583例患者为老年组，年龄<65岁的971例患者为非老年组。收集所有患者的年龄、性别、既往病史、吸烟史等基线资料，以及临床症状、心功能Killip分级、是否行经皮冠状动脉介入治疗（PCI）、术后并发症、住院期间用药、住院时间、院内死亡情况，应用logistic回归分析AMI患者全因死亡的危险因素。统计学方法采用χ²、t、Mann-Whitney U检验。结果　老年组583例患者中男393例（67.41%），年龄（74.31±7.39）岁。非老年组971例患者中男867例（89.29%），年龄（51.46±9.17）岁。老年组的男性、吸烟、肥胖、早发冠心病家族史、高脂血症患者占比和脉搏、心率、舒张压均低于非老年组，既往高血压、PCI、慢性阻塞性肺疾病（COPD）、脑血管疾病史患者占比均高于非老年组（均P<0.05）。老年组的甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高敏肌钙蛋白、左室射血分数均低于非老年组，高密度脂蛋白胆固醇（HDL-C）、氨基末端脑钠肽前体（NT-proBNP）水平均高于非老年组（均P<0.05）。无论是老年组还是非老年组患者，临床主要症状均为胸闷或胸痛。老年组的再灌注治疗率低于非老年组［93.32%（544/583）比99.18%（963/971）］，住院时间长于非老年组［10（7，12）d比9（7，11）d］，院内病死率高于非老年组［6.87%（40/583）比1.13%（11/971）］，差异均有统计学意义（均P<0.05）。多因素logistic回归分析结果显示，年龄［比值比（OR）=1.040，95%置信区间（CI）1.009～1.073，P=0.011］、心功能Killip Ⅳ级（OR=2.533，95%CI 1.053～6.095，P=0.038）、未行再灌注治疗（OR=0.250，95%CI 0.090～0.695，P=0.008）、心力衰竭（OR=3.684，95%CI 1.771～7.662，P<0.001）、休克（OR=4.005，95%CI 1.744～9.196，P=0.001）、机械并发症（OR=46.340，95%CI 6.809～315.385，P<0.001）均是AMI患者全因死亡的独立危险因素。结论　老年AMI患者的再灌注治疗率低、病死率高，年龄、心功能Killip Ⅳ级、未行再灌注治疗、心力衰竭、休克、机械并发症均为AMI患者全因死亡的独立危险因素。

关键词:

急性心肌梗死, 老年, 临床特征, 病死率, 危险因素