作者：吴颖，陈海燕，陈力量，施维

单位：

1.安徽省安庆市立医院老年科2.安徽省安庆市立医院心内科3.安徽医学高等专科学校微生物与免疫教研室

Units：

1.Department of Geriatrics, Anqing Municipal Hospital, Anqing 246003, China 2.Department of Cardiology, Anqing Municipal Hospital, Anqing 246003, China 3.Department of Microbiology and Immunology, Anhui Medical College, Hefei 230000, China

关键词：

心肌梗死; 急性ST段抬高型心肌梗死; 丹麦急性心肌梗死共病指数; 老年人; 死亡; 主要不良心血管事件;

Keywords：

Myocardial infarction; ASTEMI; DANCAMI; Aged; Death; Major adverse cardiovascular

CLC：

R 542.22

DOI：

10.12114/j.issn.1008-5971.2023.00.032

Funds：

2020年度安徽高校自然科学研究项目（KJ2020A0863）

摘要：

目的 探讨丹麦急性心肌梗死共病指数（DANCAMI）在老年急性ST段抬高型心肌梗死（ASTEMI患者中的应用价值。方法 选取2019年8月至2021年10月安庆市立医院心内科收治的161例老年ASTEMI患者为研究对象。采用床旁问卷或通过电子病历系统采集患者的临床资料，包括一般资料（性别、年龄、体质指数、收缩压、舒张压）、实验室检查指标[心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶（CK-MB）、N末端脑钠肽前体（NTproBNP）、TG、HDL-C、LDL-C、TC、白蛋白、淋巴细胞计数]，并计算DANCAMI。老年ASTEMI患者发病后6个月内死亡和发生主要不良心血管事件（MACE）的影响因素分析采用多元Cox回归分析；绘制ROC曲线以评价DANCAMI对老年ASTEMI患者发病后6个月内死亡和发生MACE的预测价值。结果 161例老年ASTEMI患者发病后6个月内死亡16例，存活145例；发生MACE 38例，未发生MACE 123例。存活和死亡患者年龄、HDL-C、淋巴细胞计数、DANCAMI比较，差异有统计学意义（P<0.05）。多元Cox回归分析结果显示，年龄、淋巴细胞计数、DANCAMI是老年ASTEMI患者发病后6个月内死亡的独立影响因素（P<0.05）。发生MACE和未发生MACE患者LDL-C、白蛋白、淋巴细胞计数和DANCAMI比较，差异有统计学意义（P<0.05）。多元Cox回归分析结果显示，淋巴细胞计数和DANCAMI是老年ASTEMI患者发病后6个月内发生MACE的独立影响因素（P<0.05）。ROC曲线分析结果显示，DANCAMI预测老年ASTEMI患者发病后6个月内死亡的AUC为0.767[95%CI(0.624,0.910)]，最佳截断值为3分，其灵敏度为93.80%，特异度为94.70%;DANCAMI预测老年ASTEMI患者发病后6个月内发生MACE的AUC为0.772[95%CI(0.692,0.852)]，最佳截断值为2分，其灵敏度为94.70%，特异度为78.50%。结论 DANCAMI是老年ASTEMI患者发病后6个月内死亡和发生MACE的独立影响因素，且其对老年ASTEMI患者发病后6个月内死亡、发生MACE具有一定预测价值。

Abstract：

Objective To explore the application value of DANish Comorbidity Index for Acute Myocardial Infarction (DANCAMI) in elderly patients with ASTEMI. Methods A total of 161 elderly patients with ASTEMI admitted to the Department of Cardiology of Anqing Municipal Hospital from August 2019 to October 2021 were selected as the study subjects. The clinical data of patients were collected by bedside questionnaire or electronic medical record system, including general information (gender, age, body mass index, systolic blood pressure, diastolic blood pressure) , laboratory examination indexes [cardiac troponin T (cTnT) , creatine kinase isoenzyme (CK-MB) , N-terminal pro-brain natriuretic peptide (NT-proBNP) , TG, HDL-C, LDL-C, TC, albumin and lymphocyte count] , and DANCAMI was calculated. Multivariate Cox regression analysis was used to analyze the influencing factors of death and major adverse cardiovascular events (MACE) within 6 months after onset in elderly patients with ASTEMI. ROC curve was drawn to evaluate the predictive value of DANCAMI for death and MACE within 6 months after onset in elderly patients with ASTEMI. Results Among the 161 elderly ASTEMI patients, 16 died and 145 survived within 6 months after onset; MACE occurred in 38 cases and MACE didn't occurred in 123 cases. There were significant differences in age, HDL-C, lymphocyte count and DANCAMI between survival patients and death patients (P < 0.05) . Multivariate Cox regression analysis showed that age, lymphocyte count and DANCAMI were independent influencing factors of death within 6 months after onset in elderly ASTEMI patients (P < 0.05) . There were significant differences in LDL-C, albumin, lymphocyte count and DANCAMI between MACE patients and non-MACE patients (P < 0.05) . Multivariate Cox regression analysis showed that lymphocyte count and DANCAMI were independent influencing factors of MACE within 6 months after onset in elderly ASTEMI patients (P < 0.05) . ROC curve analysis results showed that the AUC of DANCAMI in predicting death within 6 months after onset in elderly ASTEMI patients was 0.767 [95%CI (0.624, 0.910) ] , the optimal cut-off value was 3 points, the sensitivity was 93.80%, and the specificity was 94.70%. The AUC of DANCAMI in predicting MACE within 6 months after onset in elderly ASTEMI patients was 0.772 [95% CI (0.692, 0.852) ] , the optimal cut-off value was 2 points, the sensitivity was 94.70%, and the specificity was 78.50%. Conlclusion DANCAMI is an independent influencing factor for death and MACE within 6 months after onset in elderly patients with ASTEMI, and it has certain predictive value for death and MACE within 6 months after onset in elderly patients with ASTEMI

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