初发急性心肌梗死患者二尖瓣返流的发生率及预后——单中心6年回顾性研究

The prevalence of ischemic mitral regurgitation and its related risk in the prognosis of patients with first acute myocardial infarction——A single center 6-year retrospective study

目的:探讨初发急性心肌梗死(AMI)患者缺血性二尖瓣返流的发生率及其对患者住院期间死亡及出院患者远期预后的影响。方法:回顾性入选2000年1月至2006年1月间入院治疗的初发AMI患者,根据住院期间心脏超声检查结果,将患者分为二尖瓣无返流组、轻度、轻-中度、中-重度返流组,随访患者的远期预后。结果:在448例AMI患者中,急性期院内死亡者24例。住院期间心超结果发现二尖瓣返流发生率为67.2%,其中轻度返流为51.1%、轻-中度为9.4%、中-重度为6.7%。门诊或电话随访到患者268例(59.8%),平均随访(33.8±19.6)月,共发生死亡37例(13.8%),其中心源性死亡19例(7.1%),非心源性死亡18例(6.8%)。经多因素回归分析,死亡与二尖瓣返流的严重程度呈正相关(RR=1.504,95%CI:1.002～2.256,P=0.049),心源性死亡与缺血性二尖瓣返流显著正相关(RR=3.088,95%CI:1.767～5.395,P<0.001),均独立于入院时心功能分级(NYHA)、左室射血分数及有无靶血管重建。结论:缺血性二尖瓣返流在初发AMI患者中有较高的发生率,其对预测AMI患者的远期死亡有意义,建议纳入AMI预后的危险分层,指导今后的临床治疗。

Objective：To investigate the incidence and in-hospital or long-term prognosis of patients with ischemic mitral regurgitation （IMR） after first acute myocardial infarction （AMI）. Methods： Retrospective analysis of 448 patients who admitted to our hospital for first acute myocardial infarction from Jan. 2000 to Jan. 2006. According to their echocardiographic findins, patients with MR was assigned to different groups including no, mild, mild to moderate, and moderate or severe MR, and them were followed respectively. Results：24 patients died in hospital. Mitral regurgitation was present in 67.6% patients, of which mild MR was 51.1%, mild to moderate was 9.4% and moderate or severe was 6.7%. During an average of （33.8 ± 19.6） months, 268 patients were followed up, and 37 patients were dead, of whom 19 died of cardiovascular disease. Multivariate analysis revealed that there was a graded positive association between the presence and severity of MR and death （RR= 1. 504, 95% CI：I. 002-2. 256, P= 0. 049）, and cardiac death was significantly related to MR （RR= 3. 088 95%CI： 1. 767-5. 395, P〈0. 001）, independently of NYHA,LVEF and TLR. Conclusion：MR is frequent and often silent after AMI. It carries information to predict long-term prognosis after AMI, ＇independently of NYHA,LVEF and TLR. These findings suggest that the assessment of MR should be included in post-MI risk stratification in order to improve clinical treatment.