2023 年第 6 期 第 18 卷

不同左心室射血分数急性心肌梗死患者基本临床特征和治疗情况及院内主要不良心脑血管事件的危险因素分析

Analysis of the basic clinical characteristics and treatment statuses in acute myocardial infarction patients with different left ventricular ejection fractions and the risk factors of in-hospital major adverse cardio-cerebral vascular events

作者：尹娜1李岩2贺晓楠1

英文作者：Yin Na1 Li Yan2 He Xiaonan1

单位：1首都医科大学附属北京安贞医院急诊危重症中心，北京100029；2首都医科大学附属北京安贞医院北京市心肺血管疾病研究所流行病研究室，北京100029

英文单位：1Emergency and Critical Care Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Department of Epidemiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：急性心肌梗死；左心室射血分数；主要不良心脑血管事件

英文关键词：Acutemyocardialinfarction;Leftventricularejectionfractions;Majoradversecardio-cerebralvascularevents

• 摘要：

• 目的  探讨不同左心室射血分数（LVEF）急性心肌梗死（AMI）患者基本临床特征、治疗情况及院内主要不良心脑血管事件（MACCE）的危险因素。方法  收集2014年12月1日至2020年12月1日首都医科大学附属北京安贞医院收治的918例AMI患者的临床资料进行回顾性分析。将所有患者按照LVEF分为射血分数降低（rEF）组（LVEF≤40%，70例）、射血分数中间值（mrEF）组（40%＜LVEF＜50%，169例）、射血分数保留（pEF）组（LVEF≥50%，679例）。比较3组间基本临床特征和院内治疗情况的差异，并比较不同年龄患者之间基本临床特征的差异，采用多因素Logistic回归方法分析AMI患者院内发生MACCE的危险因素。结果  随着LVEF的降低，患者的年龄逐渐增大，心功能逐渐变差，Killip心功能Ⅱ级及以上的比例rEF组最高［30.0%（21/70）］，其次为mrEF组［20.7%（35/169）］，pEF组最低［11.5%（78/679）］，3组间差异均有统计学意义（均P＜0.01）。与年龄＜65岁患者相比，年龄≥65岁患者的LVEF更低、男性比例更低、患高血压病和糖尿病的比例更高并且心功能更差。醛固酮受体拮抗剂使用率rEF组最高［17.1%(12/70)］，其次为mrEF组［4.7%(8/169)］，pEF组最低［2.7%(18/679)］，3组间差异有统计学意义（P＜0.01）。rEF组、mrEF组和pEF组的住院时长分别为8(6,10)、7(6,9)、6(5,8)d，3组间差异有统计学意义（P<0.01）。多因素Logistic回归分析结果显示，年龄≥65岁和LVEF＜50%是AMI患者院内发生MACCE的独立危险因素（均P＜0.01）。结论  rEF和mrEF患者年龄高于、心功能差于pEF患者，年龄≥65岁患者与年龄<65岁患者相比LVEF更低、心功能更差。年龄≥65岁和LVEF＜50%是AMI患者院内发生MACCE的独立危险因素。

• Objective    To investigate the basic clinical characteristics and treatment statuses in acute myocardial infarction (AMI) patients with different left ventricular ejection fractions (LVEF) and the risk factors of in-hospital major adverse cardio-cerebral vascular events (MACCE). Methods  The clinical data of 918 AMI patients admitted to Beijing Anzhen Hospital, Capital Medical University from December 1, 2014 to December 1, 2020 were collected and retrospectively analyzed. All patients were divided into reduced ejection fraction(rEF) group(LVEF≤40%, 70 cases), mid-range ejection fraction(mrEF) group(40%<LVEF<50%, 169 cases) and preserved ejection fraction(pEF) group(LVEF≥50%, 679 cases) according to LVEF. The differences in basic clinical characteristics and in-hospital treatment among the three groups were compared, and the differences in basic clinical characteristics among patients with different ages were compared. Multivariate Logistic regression was used to analyze the risk factors of in-hospital MACCE in AMI patients. Results  With the decrease of LVEF, the ages of patients increased and the heart functions became worse. The proportion of Killip grade Ⅱ and above was the highest in the rEF group［30.0%(21/70)］, followed by the mrEF group［20.7%(35/169)］, and the lowest in the pEF group［11.5%(78/679)］, and there were significant differences among the three groups(all P<0.01). Compared with patients age < 65 years, patients age ≥65 years had lower LVEF, lower proportion of male, higher proportion of hypertension and diabetes and poorer cardiac function. The use rate of aldosterone receptor antagonists was the highest in the rEF group［17.1%(12/70)］, followed by the mrEF group［4.7%(8/169)］, and the lowest in the pEF group［2.7%(18/679)］, and there were significant differences among the three groups(P<0.01). The lengths of hospitalization in the rEF group, mrEF group and pEF group were 8(6,10), 7(6,9) and 6(5,8) d, respectively,  and there were significant differences among the three groups(P<0.01). Multivariate Logistic regression analysis showed that age ≥65 years and LVEF < 50% were the independent risk factors for in-hospital MACCE in patients with AMI (both P<0.01). Conclusions  Patients with rEF and mrEF are older and have poorer cardiac function than those with pEF, patients age≥65 years have lower LVEF and poorer cardiac function compared to patients age<65 years. Age≥65 years and LVEF<50% are independent risk factors for in-hospital MACCE in AMI patients.