Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease
Determinants of In-Hospital Death in Acute Myocardial Infarction With Triple Vessel Disease
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DOI：
10.1536/ihj.16-170
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发表时间：
2016-11-01
影响因子：
1.5
通讯作者：
Fujita, Hideo
中科院分区：
文献类型：
--
作者：
Watanabe, Yusuke;Sakakura, Kenichi;Fujita, Hideo
与单血管病变（SVD）或双血管病变（DVD）的急性心肌梗死（AMI）相比，AMI合并三血管病变（TVD）的死亡率更高。本研究的目的是确定AMI合并TVD患者院内死亡的决定因素。我们于2009年1月至2014年12月在我们三级医疗中心发现AMI患者合并TVD。基线患者特征包括实验室数据、超声心动图和冠状动脉造影从我们的医院记录中收集。我们将研究人群分为幸存者组和非幸存者组。采用多变量逐步logistic回归分析确定院内死亡的决定因素。共有138例AMI合并TVD患者被确定并纳入最终研究人群。15名患者在住院期间死亡（死亡率10.9%）。存活组的平均收缩压（134 +/- 27 mmHg）明显高于非存活组（114 +/- 31 mmHg） （P = 0.02）。入院时休克发生率在存活组（15.4%）显著低于非存活组（66.7%）（P < 0.001）。多因素逐步logistic回归分析显示，入院时休克状态（OR 11.50, 95% CI 3.21-41.14, P < 0.001）、作为梗死相关动脉（IRA）的左前降支（LAD） （OR 3.83, 95% CI 1.04-14.09, P = 0.04）和入院时血清白蛋白（OR 0.26, 95% CI 0.08-0.84, P = 0.02）与院内死亡显著相关。综上所述，AMI合并TVD患者入院时的休克状态、LAD作为IRA以及低血清白蛋白水平是院内死亡的决定因素。
Compared to acute myocardial infarction (AMI) with single vessel disease (SVD) or double vessel disease (DVD), AMI with triple vessel disease (TVD) is associated with higher mortality. The aim of this study was to identify the determinants of in-hospital death in AMI with TVD. We identified AMI patients with TVD in our tertiary medical center between January 2009 and December 2014. Baseline patient characteristics including laboratory data, echocardiograms, and coronary angiograms were collected from our hospital records. We divided our study population into a survivor group and non-survivor group. Multivariate stepwise logistic regression analysis was performed to identify the determinants of in-hospital death. A total of 138 AMI patients with TVD were identified and included as the final study population. Fifteen patients died during the hospitalization (mortality rate, 10.9%). Mean systolic blood pressure (134 +/- 27 mmHg) was significantly greater in the survivor group compared with the non-survivor group (114 +/- 31 mmHg) (P = 0.02). The prevalence of shock on admission was significantly less in the survivor group (15.4%) than in the non-survivor group (66.7%) (P < 0.001). Multivariate stepwise logistic regression analysis revealed that shock status on admission (OR 11.50, 95% CI 3.21-41.14, P < 0.001), the left anterior descending artery (LAD) as the infarct related artery (IRA) (OR 3.83, 95% CI 1.04-14.09, P = 0.04), and serum albumin on admission (OR 0.26, 95% CI 0.08-0.84, P = 0.02) were significantly associated with in-hospital death. In conclusion, shock status on admission, the LAD as the IRA, and a low serum albumin level were the determinants of in-hospital death in AMI patients with TVD.