Clinical Characteristics and Prognosis Analysis of Elderly Patients with Acute Myocardial Infarction Complicated by Multiple Diseases

目的：本研究探讨多病共患的老年急性心肌梗死(AMI)患者的临床特点及预后。方法：收集2022年01月至2023年03月巴彦淖尔市医院急诊科收住院的年龄 ≥ 60岁首次明确诊断为AMI的患者294例作为研究对象，根据合并共病数量分为：≤1种共病组(145例)、2种共病组(83例)、≥3种共病组(66例)，再根据出院1年内是否发生不良事件及是否院内死亡，分为结局良好组(243例)和结局不良组(51例)。对比不同共病数量组的基本特征、临床指标、疾病特征、治疗情况、院内不良事件以及一年内不良事件发生情况，对比结局良好组和结局不良组的共病分布情况，对比不同共病数量组的生存时间并采用Kaplan-Meier曲线分析共病数量对生存结局的影响。结果：根据共病数量分组后，女性(P = 0.029)比例、BMI (P β受体阻滞剂，2种和≥3种共病组的使用率显著高于≤1种共病组(PObjective: To examine the clinical characteristics and prognostic outcomes of elderly patients with multimorbidity and acute myocardial infarction (AMI). Methods: A total of 294 patients aged 60 years or older who were admitted to the emergency department of Bayannur Hospital between January 2022 and March 2023 and diagnosed with acute myocardial infarction (AMI) for the first time were recruited as research subjects. These patients were divided into three groups according to the number of comorbidities: one or fewer comorbidities group (145 cases), two comorbidities group (83 cases), and three or more comorbidities group (66 cases). Additionally, according to the occurrence of adverse events and in-hospital mortality within one year post-discharge, patients were further divided into a good outcome group (n = 243) and a poor outcome group (n = 51). The study compared basic characteristics, clinical indicators, disease features, treatment regimens, in-hospital adverse events, and the incidence of adverse events within one year across groups stratified by the number of comorbidities. Furthermore, the distribution of comorbidities was analyzed between the good outcome and poor outcome groups. Survival times among groups with varying numbers of comorbidities were compared using Kaplan-Meier curves to evaluate the impact of comorbidity burden on survival outcomes. Results: After stratification based on the number of comorbidities, the proportion of women (P = 0.029) and BMI (P β-blockers was significantly higher in the two and three or more comorbidities groups compared to the one or fewer comorbidity group (P < 0.001). The use of diuretics (P = 0.020) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (P = 0.006) increased with the number of comorbidities. The incidence of in-hospital heart failure (P = 0.013) and total in-hospital adverse events (P = 0.013) showed an upward trend across the three groups. The incidence of cardiogenic shock in the three or more comorbidities group was significantly higher than in the other two groups (P = 0.021). Within one year post-discharge, the risk of adverse outcomes was significantly increased in the three or more comorbidities group (P < 0.05). The proportion of patients with three or more comorbidities in the poor outcome group was significantly higher than in the good outcome group (39.22% vs. 18.93%). The average survival time of patients with three or more comorbidities was significantly shorter than that of patients with one or fewer and two comorbidities (P < 0.05). Kaplan-Meier analysis revealed that the cumulative survival rate of the three or more comorbidities group was significantly lower than that of the one or fewer comorbidity group and two comorbidities group (P < 0.05). Conclusion: In elderly AMI patients with multimorbidity, with the increase of the number of comorbidities, the proportion of women increases, the inflammation and metabolic disorders of patients become more complex, the heart function is worse, the possibility of revascularization is reduced, the burden of out-of-hospital medication is increased, the risk of in-hospital adverse events is increased, the survival time is shortened, and the prognosis is worsened.