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Title:: Risk factors of heart failure in patients with acute myocardial infarction

Author(s):: WANG Pinxiao; FANG Zhigao; FENG Xiangjun; Department of Cardiology, The second Affiliated Hospital of Wenzhou Medical Collage, Wenzhou, Zhejiang 325000,China

Keywords:: heart failure; myocardial infarction; acute; logistic multivariate regression analysis

摘要:: 目的探讨急性心肌梗死（AMI）患者并发泵衰竭的影响因素。方法以 1999年 4月至 2004年7月收住我院冠心病监护病房（CCU）的 176例AMI患者为对象，对比分析泵衰竭组（66例）与对照组（ 110例，无泵衰竭）患者的病史、临床表现、并发症等特点，以Logistic多因素逐步回归分析AMI并发泵衰竭的影响因素。结果泵衰竭组陈旧性心肌梗死病史、前壁或多部位AMI、肺部湿罗音、白细胞计数≥1.0 ×109/L、左心室射血分数≤0.5、肺炎发生率、下壁、侧壁或非Q波AMI、心肌酶峰值、住院期间病死率均与对照组有显著性差异（P<0.05或P<0.01)。Logistic多因素逐步回归分析表明，陈旧性心肌梗死病史、前壁或多部位AMI、高龄及并发肺炎是AMI患者并发泵衰竭的独立影响因素。结论 AMI患者有陈旧性心肌梗死病史、前壁或多部位AMI、高龄及并发肺炎是AMI并发泵衰竭的独立危险因素。

Abstract:: AIM To investigate the risk factors of heart failure in patients with acute myocardial infarction (AMI). METHODS One hundred and seventysix AMI patients admitted to the Wenzhou Cardiovascular Hospital from April,1999 to July,2004 were recruited in the present study. The patients in group A were associated with heart failure and those in group B were not. Their clinical characteristics, risk factors, clinical manifestation, complications and mortality during hospitalization were analyzed. RESULTS Univariate analysis indicated that history of AMI, anterior or multiple position AMI, rale in the chest, high white blood cell account (≥1.0×109/L), low left ventricular ejection fraction (<50%), as well as complication of pneumonia were significantly associated with the heart failure. The patients with heart failure had a higher mortality than those without. Multivariate logistic regression analysis showed that the major determinants of the heart failure were the history of previous myocardial infarction, anterior or multiple position AMI, old age and hospital acquired pneumonia. CONCLUSION Our observations demonstrate that the history of myocardial infarction and anterior or multiple position AMI, old age, as well as hospital pneumonia are independent risk factors of heart failure in AMI patients.