急性心肌梗塞后早期心绞痛的临床特征与预后

Clinical features and prognosis of early postinfarction angina

３８９例急性心肌梗塞患者中有６５例（１６．７％）发生梗塞后早期心绞痛，其中３１例患者接受冠脉造影，有８７．１％病例有二或三支严重血管病变。心绞痛发作时ＥＣＧ提示远离梗塞区缺血组比原梗塞区缺血组１年内不稳定心绞痛发生率更高（Ｐ＜０．０２），再梗塞发生率也有增高趋势。一年病死率分别为２３．５％和１９％。两组总死亡率为２１．１％。结果提示，这些患者中，尤其缺血发生在远离梗塞区患者，可能仍然有较多心肌处于缺血和梗塞危险，应加强药物治疗同时有条件尽早实行心导管或外科手术治疗，以期能改善预后。

Abstract Of the 389 patients with acute myocardial infarction (AMI) 16. 7% (65/389) had early postinfarction angina (within 14 days after onset of AMI). 87. 7%(57/65) of them had a past history of angina and 87.1% (27/31) had two- or three-coronaty-artery disease.Of the 65 patients, 37 had ischemia in the infarct zone, 28 at a distance. In comparisons of these two groups, left ventricular ejection fraction, peak serum myocardial enzymes and incidence of two- or three-coronary artery disease revealed no significant differences,but patients with ischemia in the infarct zone had more frequently non-Q-wave infarction (P<0.02), more patients accepted thrombolytic therapy (P<0. 05) and more patients seemed to have patent but severely narrowed infarct-related artery (66. 7% vs 30. 8%, P=0.07). In contrast, patients with ischemia at a distance had more frequently Q-wave infarction (P<0. 02) and seemed to have a higher incidence of total occlusion of infarct-related artery (69. 1% vs 33. 3%, P= 0. 07).In a follOw-up study, patients with ischemia at a distance had more frequently unstable angina (P<0.02) ,and tended to have a higher incidence of reinfarction (35. 9% vs 9. 5%, P=0. 10). One year mortality rate were 23. 5% and 19% respectively, with an overall mortality of 21. 1%. The results suggest that patients with postinfarction angina, especially those with ischemia at a distance have larger areas of the myocardium at risk for ischemia and reinfarction. Aggressive medical therapy and earlier cardiac catheterization or surgical intervention should be given, so as to improve the prognosis.