al-Adsani A, Memon A, Peneva A, Baidas G
Department of Medicine, Al-Sabah Hospital, Kuwait.
Acta Cardiol. 2000 Feb;55(1):17-23. doi: 10.2143/AC.55.1.2005713.
We studied the clinical epidemiological features of patients with AMI treated at a major hospital in Kuwait. The objectives of the study were to determine (i) personal and clinical characteristics of patients; (ii) prevalence of major risk factors among the patients; and (iii) factors associated with in-hospital morbidity and mortality.
All patients (n = 126) who fulfilled the standard diagnostic criteria for AMI and treated at the CCU of the study hospital during the calendar year 1996 were included in the study. Patients were identified from the CCU register and information was extracted from the medical records. Multiple logistic regression was performed to study the factors independently associated with in-hospital morbidity and mortality. Of the 126 patients, 84.9% were men and 15.1% were women; and 40.5% were Kuwaiti nationals and 59.5% were expatriates. On average, male patients were younger than females (mean age = 52.4 +/- 10.4 years vs. 60.2 +/- 10.2 years), and male expatriates were the youngest sub-group in the study (mean age = 49.7 +/- 8.7 years). Overall, history of diabetes, hypertension, and CHD was recorded in 44.4%, 29.6%, and 16.8% of the patients, respectively. About 58% of the male patients were current smokers and the prevalence of smoking was significantly higher in expatriates compared with Kuwaiti patients (62% vs 36%, respectively). Kuwaiti nationals had a significantly high prevalence of diabetes compared with the expatriates (57% vs 36%, respectively). There was a significant trend in increasing prevalence of diabetes, hypertension and CHD with age whereas smoking was most prevalent (87%) in the youngest age group. As for the clinical features, 70.5% of the patients presented within 6 hours of the onset of symptoms, 73% presented with ST-segment elevation (40.5% with inferior, 32.5% with anterior ST-segment elevation), and fibrinolytic therapy was given to 63.6% of the patients. About half of the patients had an admission blood glucose level of > or = 10 mmol/l, and 70.6% had a fasting blood glucose level of > or = 6.1 mmol/l one day after admission. In the multiple logistic regression analysis, old age (> 60 years), anterior MI, and admission blood glucose level of > or = 10 mmol/l were found to be significantly associated with in-hospital cardiac morbidity. The in-hospital case fatality was about 6%. Old age and history of CHD were found to be the significant predictors of in-hospital mortality.
Control of smoking and early diagnosis and appropriate treatment of diabetes may reduce the burden of AMI-related morbidity and mortality.
我们研究了科威特一家主要医院收治的急性心肌梗死（AMI）患者的临床流行病学特征。本研究的目的是确定：（i）患者的个人和临床特征；（ii）患者中主要危险因素的患病率；以及（iii）与住院期间发病率和死亡率相关的因素。
所有符合AMI标准诊断标准且于1996年在研究医院冠心病监护病房（CCU）接受治疗的患者（n = 126）均纳入本研究。从CCU登记册中识别患者，并从病历中提取信息。进行多因素logistic回归分析以研究与住院期间发病率和死亡率独立相关的因素。126例患者中，84.9%为男性，15.1%为女性；40.5%为科威特国民，59.5%为外籍人士。平均而言，男性患者比女性患者年轻（平均年龄 = 52.4 ± 10.4岁 vs. 60.2 ± 10.2岁），男性外籍人士是研究中最年轻的亚组（平均年龄 = 49.7 ± 8.7岁）。总体而言，分别有44.4%、29.6%和16.8%的患者有糖尿病、高血压和冠心病病史。约58%的男性患者为当前吸烟者，外籍人士的吸烟患病率显著高于科威特患者（分别为62%和36%）。与外籍人士相比，科威特国民的糖尿病患病率显著较高（分别为57%和36%）。糖尿病、高血压和冠心病的患病率随年龄增长有显著上升趋势，而吸烟在最年轻年龄组中最为普遍（87%）。至于临床特征，70.5%的患者在症状发作后6小时内就诊，73%表现为ST段抬高（40.5%为下壁，32.5%为前壁ST段抬高），63.6%的患者接受了溶栓治疗。约一半的患者入院血糖水平≥10 mmol/l，70.6%的患者入院一天后空腹血糖水平≥6.1 mmol/l。在多因素logistic回归分析中，发现老年（>60岁）、前壁心肌梗死和入院血糖水平≥10 mmol/l与住院期间心脏发病率显著相关。住院病死率约为6%。发现老年和冠心病病史是住院死亡率的显著预测因素。
控制吸烟以及糖尿病的早期诊断和适当治疗可能会减轻与AMI相关的发病率和死亡率负担。
