老年急性ST段抬高型心肌梗死患者发生 院内心衰的危险因素分析

Risk Factors Analysis of In-Hospital Heart Failure in Elderly Patients with Acute ST-Segment Elevation Myocardial Infarction

摘要: 目的：探讨老年急性ST段抬高型心肌梗死(STEMI)患者住院期间发生心力衰竭的危险因素，为早期识别高危个体、优化临床管理策略提供循证依据。方法：回顾性分析2020年1月至2025年1月新疆生产建设兵团第三师总医院235例行经皮冠状动脉介入治疗的老年下壁STEMI患者临床资料，根据院内心衰发生情况分为观察组(71例，发生心衰)和对照组(164例，未发生心衰)，收集患者临床指标并进行单因素分析，将有统计学意义的指标纳入多因素logistic回归分析筛选独立危险因素，通过ROC曲线分析各指标及联合模型的预测效能。结果：单因素分析显示，两组在年龄、NT-proBNP、血清肌酐等多项指标上差异有统计学意义(P < 0.05)；多因素logistic回归分析证实，年龄、NT-proBNP、左心室射血分数(LVEF)、左心室舒张末容积(LVEDV)、发病至入院时间、入院时Killip分级 ≥ 3级是老年STEMI患者院内心衰的独立危险因素(P < 0.05)；ROC曲线分析显示，单一指标中LVEF预测效能最佳(AUC = 0.845)，多指标联合模型预测效能显著更高(AUC = 0.931)，最佳截断值0.416时灵敏度88.7%、特异度85.4%。结论：老年STEMI患者院内心衰的发生受多因素共同影响，年龄、NT-proBNP、LVEF等为独立危险因素，多指标联合模型对院内心衰具有极高的预测价值，临床可据此早期识别高危患者并实施针对性干预，以改善患者近期预后。

Abstract: Objective: To investigate the risk factors for heart failure during hospitalization in elderly patients with acute ST-segment elevation myocardial infarction (STEMI), providing evidence-based insights for early identification of high-risk individuals and optimization of clinical management strategies. Methods: A retrospective analysis was conducted on clinical data of 235 elderly patients with inferior wall STEMI who underwent percutaneous coronary intervention (PCI) at the Third Division General Hospital of Xinjiang Production and Construction Corps from January 2020 to January 2025. Patients were divided into an observation group (71 cases, with heart failure) and a control group (164 cases, without heart failure) based on hospital incidence of heart failure. Clinical indicators were collected and analyzed using univariate analysis. Statistically significant indicators were included in multivariate logistic regression analysis to screen independent risk factors, and the predictive efficacy of individual indicators and combined models was evaluated through ROC curve analysis. Results: Univariate analysis revealed statistically significant differences between the two groups in multiple parameters including age, NT-proBNP, and serum creatinine (P < 0.05). Multivariate logistic regression analysis confirmed that age, NT-proBNP, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), time from onset to hospital admission, and Killip classification ≥ 3 at admission were independent risk factors for in-hospital heart failure in elderly STEMI patients (P < 0.05). ROC curve analysis demonstrated that LVEF exhibited the highest predictive efficacy among single indicators (AUC = 0.845), while the combined multi-indicator model showed significantly improved predictive performance (AUC = 0.931). The optimal cutoff value of 0.416 achieved a sensitivity of 88.7% and specificity of 85.4%. Conclusion: The occurrence of in-hospital heart failure in elderly STEMI patients is influenced by multiple factors, with age, NT-proBNP, and LVEF being independent risk factors. A multi-index combined model demonstrates high predictive value for in-hospital heart failure, enabling early identification of high-risk patients and implementation of targeted interventions to improve short-term prognosis.