关键词: 心肌梗死；ST段抬高型心肌梗死；老年人, 80以上；高龄；出院后医疗；死亡率

Abstract: Background　Population ageing has led to an increase in the number of elderly patients with ST-segment elevation myocardial infarction（STEMI） receiving percutaneous coronary intervention（PCI）. Coexistence of diseases，frailty，impaired immunity，poor nutritional status and other conditions may occur in elderly patients，which may have an impact on their recovery and return to their families. There is a lack of a comprehensive assessment on the relationship between this group's discharge destination and prognosis. Objective　To assess the relationship between discharge destination and medium-term mortality in 80-year-old STEMI survivors receiving PCI. Methods　A retrospective analysis was conducted on STEMI patients undergoing PCI in Haikou People's Hospital from December 2015 to December 2018，with the following information collected，including general data〔age，gender，BMI，hospital stays，major medical histories （heart failure，myocardial infarction，PCI，coronary artery bypass grafting，stroke，gastrointestinal bleeding，peripheral arterial disease，dyslipidemia，diabetes，hypertension，smoking，chronic kidney disease，systolic pressure，diastolic pressure，heart rate，Killip classification），proportion of left ventricular ejection fraction（LVEF） <40%〕，laboratory findings〔hemoglobin，albumin，white blood cell count，C-reactive protein，blood glucose，peak CK during hospitalization〕，pathological features of coronary artery〔left main coronary artery（LMCA），left anterior descending artery（LADA），left circumflex artery（LCXA），right coronary artery （RCA），number of patients with 2-vessel disease and time from symptom onset to reperfusion〕，post-discharge medication （aspirin，clopidogrel or ticagrelor，warfarin，new oral anticoagulants，statins，ACEI/ARB，calcium receptor antagonist，β-receptor blocker） and severe debilitating condition. The follow-up started at discharge and ended in December 2020，with the terminal event of being all-cause death. Logistic regression analysis was used to explore the influencing factors of all-cause death. Results　In all，2 450 patients completed thefollow-up，including 2 090 who were discharged to home （home discharge group） and 360 to other facilities （non-home discharge group）. During the follow-up period，370 patients（17.5%） died after discharge，and the most common cause of death was infection（21.6%，80/370），followed by sudden death（18.9%，70/370） and heart failure（16.2%，60/370）. The cardiovascular death rate of the homedischarge group was higher than that of the non-homedischarge group（P<0.05）. Two groups showed significant differences in the cumulative mortality curve（P<0.05）. Univariate Logistic regression analysis showed that non-home discharge，previous heart failure，lesions in the LADA，serum albumin <35 g/L，LVEF<40% may be the risk factors of all-cause death during follow-up （P<0.05）. Further multivariate Logistic regression analysis showed that LVEF<40%〔OR=3.161，95%CI（1.564，6.389），P=0.001〕，previous heart failure〔OR=4.899，95%CI（1.835，13.078），P=0.002〕，non-homedischarge〔OR=2.617，95%CI（1.188，5.765），P=0.049〕，lesions in the LADA〔OR=2.210，95%CI（1.137，4.295），P=0.019〕，albumin level<35 g/L〔OR=2.147，95%CI（1.064，4.330），P=0.033〕 were all risk factors of death during follow-up period. Conclusion　There is a relationship between non-family discharge and an increased risk of medium-term mortalityin STEMI patients over the age of 80. Active searching for causes of non-homedischarge and early delivering targeted interventions may reduce the medium-term mortality in thesepatients.

Key words: Myocardial Infarction；ST Elevation Myocardial Infarction；Aged, 80 and over；Elderly；Aftercare；Mortality