重症监护室急性心肌梗死老年患者痴呆症与不良预后的关系倾向得分分析

IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS International heart journal Pub Date : 2024-07-13 DOI:10.1536/ihj.23-618
Li Luo, Linhao Jian, Quan Zhou, Xiangjie Duan, Liangqing Ge
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引用次数: 0

摘要

痴呆症限制了急性心肌梗死(AMI)患者及时进行血管重建。然而,对于重症监护室(ICU)中患有急性心肌梗死的老年人来说,痴呆症是否会对预后产生负面影响仍不清楚。这项研究旨在评估痴呆症对重症监护室中急性心肌梗死患者预后的影响。研究人员评估了重症监护医学信息市场IV(MIMIC IV)数据库中3582名年龄≥65岁的重症监护室急性心肌梗死患者的数据。自变量是基线时的痴呆,主要发现是随访期间任何原因导致的死亡。1:1倾向得分匹配(PSM)显示,208名参与者患有痴呆症,208名参与者未患有痴呆症。在倾向得分匹配队列中,痴呆组和非痴呆组的30天全因死亡率分别为37.50%和33.17%(P = 0.356),1年全因死亡率分别为61.06%和51.44%(P = 0.048)。Cox回归分析表明,痴呆与急性心肌梗死后30天(危险比[HR]1.15,95%置信区间[CI]0.84,1.60)和1年(HR 1.28,95%置信区间[CI]0.99,1.66)全因死亡率升高没有关系。同样,痴呆与急性心肌梗死后的院内死亡率、出血或中风没有关系。交互分析显示,患有痴呆症和糖尿病并发症的患者的1年全因死亡率比没有糖尿病并发症的患者高48.00%。因此,将痴呆列为急性心肌梗死侵入性治疗的禁忌症可能并不恰当。
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Association of Dementia with Adverse Outcomes in Older Patients with Acute Myocardial Infarction in the ICU A Propensity Score Analysis

Dementia limits timely revascularization in individuals with acute myocardial infarction (AMI). However, it remains unclear whether dementia affects prognosis negatively in older individuals with AMI in the intensive care unit (ICU). This research aimed to evaluate the dementia effect on the outcomes in individuals with AMI in ICU.

Data from 3,582 patients aged ≥ 65 years with AMI in ICU from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were evaluated. The independent variable was dementia at baseline, and the primary finding was death from any cause during follow-up. A 1:1 propensity score matching (PSM) showed 208 participants with and without dementia. The correlation between dementia and poor prognosis of AMI was verified using a double-robust estimation method.

In the PSM cohort, the 30-day all-cause mortality was 37.50% and 33.17% in the dementia and non-dementia groups (P = 0.356), respectively, and the 1-year all-cause mortality was 61.06% and 51.44%, respectively (P = 0.048). Cox regression analysis showed no association between dementia and elevated 30-day (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84, 1.60) and 1-year (HR 1.28, 95% CI 0.99, 1.66) all-cause mortality after AMI. Similarly, dementia was not connected with in-hospital mortality, bleeding, or stroke after AMI. Interaction analysis showed that 1-year all-cause mortality was 48.00% higher in individuals with dementia and diabetic complications than in those without diabetic complications.

Dementia is not an independent risk factor for adverse outcomes in AMI. Thus, it may be inappropriate to include dementia as a contraindication for invasive AMI therapy.

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来源期刊
International heart journal
International heart journal 医学-心血管系统
CiteScore
2.50
自引率
6.70%
发文量
148
审稿时长
6-12 weeks
期刊介绍: Authors of research articles should disclose at the time of submission any financial arrangement they may have with a company whose product figures prominently in the submitted manuscript or with a company making a competing product. Such information will be held in confidence while the paper is under review and will not influence the editorial decision, but if the article is accepted for publication, the editors will usually discuss with the authors the manner in which such information is to be communicated to the reader.
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