Wang Juan, Yang Yan-min, Zhu Jun, Tan Hui-qiong, Liu Li-sheng
Department of Emergency and Intensive Care Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Jul;41(7):549-58.
To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated with fatal arrhythmia.
We analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial. Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables.
The overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [(66.1 ± 11.9) years and 62.4% male] was 52.9%. Logistic regression analysis showed that age (OR = 1.82, 95%CI:1.449-2.285), anterior infarction (OR = 4.419, 95%CI:2.645-7.384), heart rate > 60 bpm (OR = 3.32, 95%CI:1.898- 5.808), killip class IV (OR = 3.686, 95%CI:1.684-8.06), admission hemoglobin A1c < 5.6% (OR = 2.564, 95%CI:1.199-5.484), no use of ACEI (OR = 1.827, 95%CI:1.099-3.038) and no use of lipid-low drugs (OR = 2.034, 95%CI:1.196-3.458) were independent risk factors for short term mortality after STEMI. The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0.830 (95%CI: 0.796-0.865) and 0.866 (95%CI: 0.835-0.896), respectively.
The 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high. Age, anterior infarction, heart rate > 60 bpm, killip class IV, admission hemoglobin A1c level < 5.6%, no use of ACEI and no use of lipid-low drugs are independent risk factors for 30-day mortality in these patients.
探讨ST段抬高型急性心肌梗死（STEMI）合并致命性心律失常患者短期死亡的独立危险因素。
我们分析了纳入CREATE试验的中国STEMI合并致命性心律失常患者的数据。采用单因素和多因素逻辑回归分析，利用基线和治疗变量确定STEMI后30天死亡率的预测因素。
718例STEMI合并致命性心律失常患者（年龄[66.1±11.9]岁，男性占62.4%）的30天总死亡率为52.9%。逻辑回归分析显示，年龄（比值比[OR]=1.82，95%置信区间[CI]：1.449-2.285）、前壁梗死（OR=4.419，95%CI：2.645-7.384）、心率>60次/分钟（OR=3.32，95%CI：1.898-5.808）、Killip分级IV级（OR=3.686，95%CI：1.684-8.06）、入院时糖化血红蛋白A1c<5.6%（OR=2.564，95%CI：1.199-5.484）、未使用血管紧张素转换酶抑制剂（ACEI）（OR=1.827，95%CI：1.099-3.038）以及未使用降脂药物（OR=2.034，95%CI：1.196-3.458）是STEMI后短期死亡的独立危险因素。预测基线和临床变量模型死亡情况的受试者工作特征曲线下面积分别为0.830（95%CI：0.796-0.865）和0.866（95%CI：0.835-0.896）。
STEMI合并致命性心律失常患者的30天死亡率很高。年龄、前壁梗死、心率>60次/分钟、Killip分级IV级、入院时糖化血红蛋白A1c水平<5.6%、未使用ACEI以及未使用降脂药物是这些患者30天死亡率的独立危险因素。
