Ivanusa Mario, Milicić Davor, Bozikov Jadranka, Ivanusa Zrinka
Opća bolnica Bjelovar, Bjelovar, Klinicki bolnicki centar Zagreb, Hrvatska.
Acta Med Croatica. 2007 Jun;61(3):307-13.
To determine whether there are any differences in the prevalence of risk factors between survivors and nonsurvivors among acute myocardial infarction (AMI) patients hospitalized in a county hospital.
Case histories of AMI patients treated at Department of Medicine, Bjelovar General Hospital from July 1, 1996 until December 31, 2000 were retrospectively analyzed. AMI was diagnosed using the World Health Organization definition. Demographic factors (age and sex), smoking habits, clinical and laboratory results (hypertension, diabetes, blood lipids--total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides), personal history of angina pectoris, myocardial infarction and stroke and family history of atherothrombotic disease were considered as potential risk factors. Comparisons were made between survivors and nonsurvivors during hospital treatment. On group comparisons Student's t-test and chi2-test were used. Statistical significance was set at p<0.05.
In a total of 396 study patients, there were 316 (79.8%) survivors, showing male predominance (87.1% vs 67.3% of women; p<0.011). The patients aged under 65 were mainly male (79.6%), and among those older than 65 both sexes were equally represented (male 50.7% vs female 49.3%). Hypertension was more common in women (55.1% vs 42.6%; p=0.016), and smoking in men (31.7% vs 5.4%; p<0.001). The group survivors showed a higher prevalence of hypertension (50.3% vs 35.0% in nonsurvivors; p=0.014) and smoking (25.9% vs 6.3%; p<0.001). The prevalence of diabetes, previous myocardial infarction, angina pectoris, previous stroke and family history of atherothrombotic disease showed no statistically significant differences between survivors and nonsurvivors. Furthermore, a greater number of patients with increased levels of total cholesterol (> or =5.0 mmol/L) and LDL-cholesterol (> or =3.0 mmol/L) were found in the group of survivors than among nonsurvivors. The latter were 8 years older than survivors (71.0+/-9.3 vs 63.0+/-11.9 years; p<0.001). Analysis according to age groups also showed a rise of hospital mortality with age group in both sexes (men: 4.6% in <55 age group vs 22.6% in > or =75 age group; women: 7.1% in <55 age group vs 43.7% in > or =75 age group). A higher percentage of men nonsurvivors were smokers in comparison to female nonsurvivors that also had a lower level of total cholesterol. The prevalence of hypertension showed no significant sex difference.
The prevalence of risk factors, especially the most important ones, i. e. hypertension, smoking and abnormal lipid values in AMI patients should be considered according to sex and age. The impact of these factors on patient outcome, i. e. survival rate during hospital treatment, can only be analyzed taking into account sex and age.
确定在一家县级医院住院的急性心肌梗死（AMI）患者中，幸存者与非幸存者之间危险因素的患病率是否存在差异。
回顾性分析1996年7月1日至2000年12月31日在比耶洛瓦尔综合医院内科治疗的AMI患者的病历。AMI采用世界卫生组织的定义进行诊断。人口统计学因素（年龄和性别）、吸烟习惯、临床和实验室检查结果（高血压、糖尿病、血脂——总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯）、心绞痛、心肌梗死和中风的个人病史以及动脉粥样硬化血栓形成疾病的家族史被视为潜在危险因素。对住院治疗期间的幸存者和非幸存者进行比较。组间比较采用学生t检验和卡方检验。统计学显著性设定为p<0.05。
在总共396例研究患者中，有316例（79.8%）幸存者，男性占优势（87.1%对女性的67.3%；p<0.011）。65岁以下的患者主要为男性（79.6%），65岁以上的患者中男女比例相当（男性50.7%对女性49.3%）。高血压在女性中更常见（55.1%对42.6%；p=0.016），吸烟在男性中更常见（31.7%对5.4%；p<0.001）。幸存者组中高血压（50.3%对非幸存者的35.0%；p=0.014）和吸烟（25.9%对6.3%；p<0.001）的患病率更高。糖尿病、既往心肌梗死、心绞痛、既往中风和动脉粥样硬化血栓形成疾病家族史的患病率在幸存者和非幸存者之间无统计学显著差异。此外，幸存者组中总胆固醇（≥5.0 mmol/L）和低密度脂蛋白胆固醇（≥3.0 mmol/L）水平升高的患者数量多于非幸存者组。后者比幸存者大8岁（71.0±9.3岁对63.0±11.9岁；p<0.001）。按年龄组分析还显示男女住院死亡率均随年龄组增加（男性：<55岁年龄组为4.6%对≥75岁年龄组为22.6%；女性：<55岁年龄组为7.1%对≥75岁年龄组为43.7%）。与女性非幸存者相比，男性非幸存者中吸烟者的比例更高，而女性非幸存者的总胆固醇水平也较低。高血压的患病率无显著性别差异。
AMI患者危险因素的患病率，尤其是最重要的危险因素，即高血压、吸烟和血脂异常，应根据性别和年龄来考虑。这些因素对患者预后，即住院治疗期间生存率的影响，只有在考虑性别和年龄的情况下才能进行分析。
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