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目的分析高龄急性心肌梗死(AMI)患者的住院死亡原因及相关危险因素。方法选择1999年1月～2003年12月住院年龄≥70岁的AMI患者459例,分为死亡病例组(51例)和非死亡病例组(408例)。对病史资料进行回顾性研究,比较两组临床特征,记录死亡原因,分析死亡高危因素。结果5年间年龄≥70岁AMI患者住院总病死率11.1%。死于心力衰竭15例(29.4%),心源性休克13例(25.5%),致死性心律失常-室颤8例(15.7%),心脏破裂6例(11.8%),肺部感染-呼吸衰竭6例(11.8%),急性肺栓塞和脑卒中3例(5.9%),其中31例(60.8%)死于入院48h内。死亡病例组前壁心梗、既往心梗、心衰和糖尿病史4项临床特征明显高于非死亡病例组,有统计学意义。结论高龄AMI患者死亡率高,死亡多发生于病程早期,心力衰竭、心源性休克和室颤是主要死因,前壁心梗、既往心梗、心衰和糖尿病史是死亡的重要危险因素。
Objective To analyze the causes of death from hospitalizations and related risk factors in elderly patients with acute myocardial infarction (AMI). Methods From January 1999 to December 2003, 459 AMI patients with hospitalization ≥70 years old were divided into death group (51 cases) and non-death cases group (408 cases). The medical history data were retrospectively studied. The clinical features of the two groups were compared, the cause of death was recorded and the risk factors of death were analyzed. Results The overall hospital mortality rate of AMI patients aged ≥70 years over the five years was 11.1%. 15 (29.4%) died of heart failure, 13 (25.5%) had cardiogenic shock, 8 (15.7%) had ventricular arrhythmia - ventricular fibrillation, 6 (11.8%) had heart failure, 6 cases (11.8%) had failure, 3 cases (5.9%) had acute pulmonary embolism and stroke, and 31 cases (60.8%) died within 48 hours after admission. There were 4 clinical features of anterior myocardial infarction, previous myocardial infarction, heart failure and diabetes mellitus in death group, which were significantly higher than those in non-death group, with statistical significance. Conclusion The mortality rate of AMI patients is higher than that of AMI patients. The death mostly occurs in the early course of disease. Heart failure, cardiogenic shock and ventricular fibrillation are the major causes of death. The anterior myocardial infarction, previous myocardial infarction, heart failure and diabetes mellitus are important risk factors of death.