| Objective: This study aimed to investigate the frailty,surface electrocardiogram,echocardiography layered graph indexes and biochemical indexes of patients with cardiac sudden death in elderly patients with acute myocardial infarction predictive value,to identify high-risk sudden death in elderly patients with myocardial infarction after early intervention to reduce acute myocardial infarction in elderly patients hospitalized rate of sudden death.Methods: from December 2012 December-2016 year in Qiingdao University Affiliated Hospital of geriatrics and Department of Cardiology diagnosis for elderly patients with acute myocardial infarction in 660 cases,and the clinical data were collected from patients when ECG,echocardiography and within 24 hours of the related biochemical indexes,follow-up time of hospital stay,observe the end point for sudden cardiac death(fatal cardiac arrhythmia,acute heart failure,rupture,cardiac tamponade,cardiac arrest or recovery).Using univariate and multivariate COX regression analysis,using the product limit method(Kaplan-Meier method)for end point event trace survival curve significant variables for the Log-rank test,area of application of ROC work under the curve sum evaluation have the effect of SCD can predict the significance of evaluation index,and the sensitivity and specificity of significance index.SPSS 22 software was used for statistical analysis,and the value of P was less than 0.05 as statistically significant.Results: 1.frailty: the prevalence rate of the SCD group was significantly higher than that in the survival group(P < 0.05).The multiple factor COX regression analysis showed that the decline was an independent predictor of SCD in the elderly patients with acute myocardial infarction,and the risk ratio was 3.053(95%CI 2.014 ~ 4.628).2.noninvasive index: compared with the survival group,the QRS wave width of the SCD group was obviously prolonged,the LVEF was obviously decreased and the LVMI was significantly increased(P < 0.05),but there was no significant difference in the QTc interval(P > 0.05).Multiple factor COX regression analysis showed that QRS wave width and LVEF were independent predictors of SCD in elderly patients with acute myocardial infarction,the risk ratio was 1.003(95%CI 1.001 to 1.005,P=0.005),0.971(95%CI 0.952 ~ 0.990,P=0.003),and the best diagnosis of QRS wave width was calculated by the ROC working curve.3.biochemical indexes: compared with the survival group,the serum levels of ADL,K+,Tn I and BNP in the SCD group were significantly higher(P < 0.05),and the serum HB,ALB and GFR levels were significantly decreased(P < 0.05),but there was no significant difference in the HDL level between the two groups(P > 0.05).Multiple factor COX regression analysis showed that K+,Tn I and BNP were independent predictors of SCD in elderly patients with acute myocardial infarction,the risk ratio was 1.416(95%CI 1.135 to 1.765,P=0.002),1.022(95%CI 1.005 to 1.040,P=0.019),1.098 to 2.784,P=0.000),and the best diagnostic cut-off points were calculated by the ROC working curve.4.the multiple factor COX regression analysis of debilitating,QRS,LVEF,K+,Tn I and BNP still suggested that the independent predictors of SCD in the elderly patients with acute myocardial infarction increased and the area under the ROC curve of the combined prediction of SCD increased to 92.5%.Conclusion: the results of this study appear in elderly patients with acute myocardial infarction,electrocardiogram QRS wave decline more than 105 ms,echocardiography and LEVF≤35% within 24 hours after admission test results K+≥4.99mmol/L,Tn I≥2.52ug/L,BNP≥523.5pg/ml,the risk of SCD patients,and combined with the above indexes in patients with more risk the greater the SCD. |
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