目的：探讨80岁以上急性心肌梗死患者临床和冠脉病变特点。方法：2008年10月至2013年10月中日友好医院收治的急性心肌梗死(AMI)患者中有132例年龄>80岁，其中80例行冠状动脉造影。收集研究对象的临床和冠状动脉造影(CAG)资料，对其进行回顾性分析。结果：132例患者平均年龄83.80 ± 3.57岁，男性86例，女性46例，64例以胸痛为主要症状，68例无典型胸痛表现。最常见的危险因素是高血压(92例)和高脂血症(92例)。急性ST段抬高型心肌梗死(STEMI)80例，下壁心梗受累例数最多(48例)，急性非ST段抬高型心肌梗死(NSTEMI)52例。其中的116例患者超声心动(UCG)左室射血分数(LVEF) 52.41% ± 13.81%，包括24例LVEF < 40%。80例行CAG患者中38例梗死相关动脉(IRA)为RCA，44例患者病变血管有6支。死亡20例，最常见的并发症是心律失常(92例)和肾衰竭(50例)。结论：80岁以上AMI患者临床表现多样，NSTEMI比例较年轻人增高，高血压和高脂血症为最常见危险因素，下壁心梗、3只血管病变、IRA为RCA最常见，死亡率高，最常见的并发症是心律失常和肾衰竭。 Aims: We aim to investigate the characteristics of patients older than the age of 80 with acute myocardial infarction (AMI). Methods: This retrospective study included 132 patients older than 80 years with AMI, 80 patients underwent Coronary Angiography (CAG). All patients were admitted and treated in our hospital from Oct. 2008 to Oct. 2013. We evaluated their clinical features and CAG. Results: The mean age was 83.80 ± 3.57 years old, 86 were males and 46 were females. Sixty-four patients presented typical chest pain, 68 patients didn’t present chest pain. Hypertension (92) and hyperlipidmia (92) were the most common risk factors. ST segment elevation infarction (STEMI) was present in 80 patients; the most common infarction area was inferior wall (48). None ST segment elevation infarction (NSTEMI) was present in 52 patients. The mean left ventricule ejection fraction (LVEF) of one hundred and sixteen patients was 52.41% ± 13.81%, especially 24 patients LVEF < 40%. Eighty patients underwent coronary angiography, right coronary artery (RCA) was the most frequent Infarct-Related Artery (IRA) (38). Forty-four patients had three vessels disease. Twenty patients died; the most common complications were arrithymia (92) and renal failure (50). Conclusions: The clinic manifestations of patients older than 80 years with AMI were various. NSTEMI ratio was relatively high comparing with younger. Hypertension and hyperlipidemia were the most common risk factors. The most frequent situations were inferior wall MI, three vessels disease, and RCA being the IRA. Mortality was high, and the most common complications were arrithymia and renal failure.
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