肾功能不全是急性心肌梗死患者院内死亡和心室破裂的独立预测因素。

Renal Dysfunction was an Independent Predictor of In-Hospital Death and Ventricular Rupture in Patients With Acute Myocardial Infarction.

作者信息

Goto Masayuki, Oda Eiji, Matsushita Hirooki, Takarada Ken, Tomita Makoto, Saito Atsushi, Fuse Koichi, Fujita Satoru, Ikeda Yoshio, Kitazawa Hitoshi, Takahashi Minoru, Sato Masahito, Okabe Masaaki, Aizawa Yoshifusa

机构信息

Cardiovascular Center, Tachikawa Medical Center, Nagaoka, Japan.

Medical Check-up Center, Tachikawa Medical Center, Nagaoka, Japan.

出版信息

Cardiol Res. 2012 Jun;3(3):123-132. doi: 10.4021/cr184w. Epub 2012 May 20.

DOI:10.4021/cr184w

PMID:28352408

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5358241/

Abstract

BACKGROUND

Apart from the severity of myocardial infarction and coronary artery disease, several predictors of in-hospital death (In-HD) are suggested in patients with acute myocardial infarction (AMI).

METHODS

We investigated predictors of In-HD and ventricular rupture (VR) including ventricular septal rupture (VSR) and free wall rupture (FWR) with stepwise multivariable logistic regressions in 1,042 patients admitted to our Cardiovascular Center within 48 hours from symptom onset for the first attack of AMI.

RESULTS

In-HD, VSR, and FWR were observed in 78 cases (7.5%), 14 cases of which 13 cases were In-HD, and 13 cases of which 6 cases were In-HD, respectively. Apart from the disease severity, age and renal dysfunction (RD) defined by estimated glomerular filtration rate of lower than 60 mL/min/ 1.73 m were independent positive predictors of In-HD (the odds ratios (ORs) (95% confidence interval (CI)): 1.04 (1.01 - 1.06) P = 0.0069 and 5.75 (3.12 - 10.59) P < 0.0001, respectively) and hypercholesterolemia was an independent negative predictor for In-HD (OR (95% CI): 0.34 (0.17 - 0.67) P = 0.0017). After including the categories of coronary disease, ventricular rupture, and ejection fraction in predictors, RD remained an independent predictor of In-HD (OR (95% CI): 6.65 (2.67 - 16.60) P < 0.0001). Age (OR (95% CI): 1.07 (1.02 - 1.12) P = 0.0064), RD (OR (95% CI): 2.77 (1.18 - 6.49) P = 0.019), and diabetes (OR (95% CI): 2.52 (1.12 - 5.71) P = 0.026) were independent predictors of VR.

CONCLUSIONS

RD was an independent predictor of In-HD and VR in patients with initial AMI.

摘要

背景

除了心肌梗死和冠状动脉疾病的严重程度外，急性心肌梗死（AMI）患者还存在一些院内死亡（In-HD）的预测因素。

方法

我们采用逐步多变量逻辑回归分析，对1042例因首次发作AMI在症状发作后48小时内入住我院心血管中心的患者进行了In-HD及心室破裂（VR）（包括室间隔破裂（VSR）和游离壁破裂（FWR））预测因素的研究。

结果

分别有78例（7.5%）、14例（其中13例伴有In-HD）和13例（其中6例伴有In-HD）患者发生In-HD、VSR和FWR。除疾病严重程度外，年龄和估算肾小球滤过率低于60 mL/min/1.73 m²所定义的肾功能不全（RD）是In-HD的独立阳性预测因素（比值比（OR）（95%置信区间（CI））：分别为1.04（1.01 - 1.06），P = 0.0069和5.75（3.12 - 10.59），P < 0.0001），而高胆固醇血症是In-HD的独立阴性预测因素（OR（95%CI）：0.34（0.17 - 0.67），P = 0.0017）。在预测因素中纳入冠心病、心室破裂和射血分数类别后，RD仍然是In-HD的独立预测因素（OR（95%CI）：6.65（2.67 - 16.60），P < 0.0001）。年龄（OR（95%CI）：1.07（1.02 - 1.12），P = 0.0064）、RD（OR（95%CI）：2.77（1.18 - 6.49），P = 0.019）和糖尿病（OR（95%CI）：2.52（1.12 - 5.71），P = 及心室破裂（VR）的独立预测因素。