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目的探讨老年急性心肌梗死（ＡＭＩ）患者近期转归的影响因素，为降低病死率提供理论依据。方法连续住院的３０５例首次ＡＭＩ老年患者，男１４６例，女１５９例，对比分析其临床基础情况、梗死表现、治疗及临床经过、住院病死率及死亡原因，并对影响转归的变量进行多元回归分析。结果老年女性并存高血压和糖尿病的百分率较男性高（分别为５６％对２９％，３３％对１８％），男性吸烟者较女性多（４０％对２％），差异均有显著性（均为Ｐ＜０．０１）。老年女性的心力衰竭、休克、机械并发症和住院病死率均高于男性（均为Ｐ＜０．０５）。然而，多元回归分析显示，性别并不是住院死亡的独立危险因子（ＯＲ，０．７３；９５％ＣＩ，０．２５～２．２３），而心功能Ｋｉｌｉｐ分级（ＯＲ，６．８２；９５％ＣＩ，２．５０～１８．９１）、机械并发症（ＯＲ，５３．１８；９５％ＣＩ，１１．５６～４０１．３０）、肌酸激酶（ＣＰＫ）峰值（ＯＲ，１．６９；９５％ＣＩ，１．１８～２．４７）等可能有重要预后价值。结论老年ＡＭＩ患者死亡危险性增加与心脏本身的危险因子有关，而性别无重要影响。
Objective To investigate the influencing factors of recent outcomes in elderly patients with acute myocardial infarction (AMI) and provide a theoretical basis for reducing mortality. Methods A total of 305 first-time AMI patients were enrolled in this study. Among them, 146 were males and 159 were males. The clinical basis, infarct manifestations, treatment and clinical course, hospital mortality and causes of death were compared and analyzed. The variables influencing prognosis were multivariate regression analysis. Results Elderly women had higher rates of hypertension and diabetes than men (56% vs 29% and 33% vs 18%, respectively), and more male smokers than women (40% vs 2%) (both P <0.01). Heart failure, shock, mechanical complications and hospital mortality in older women were higher than those in men (P <0.05, respectively). However, multiple regression analysis showed that gender was not an independent risk factor for in-hospital death (OR, 0.73; 95% CI, 0.25-2.23), whereas Kilip class of heart function (OR, 6.82; 95% CI, 2.50-18.91), mechanical complications (OR, 53.18; 95% CI, 11.56-401.30), peak creatine kinase (CP) CI, 1.18 ~ 2.47) may have important prognostic value. Conclusion The increased risk of death in elderly patients with AMI is related to the risk factors of heart itself, but no significant gender effects.