陈旧性心肌梗塞患者无症状心肌缺血性ST段改变及其随访分析

Follow-up and prognosls of asymptomatic myocardlalischemia in patients with old myocardiac infarction

应用动态心电图监测７８例陈旧性心肌梗塞患者，根据有无无症状性ＳＴ段改变随机分为两组：有无症状性ＳＴ段改变组４１例，无ＳＴ段改变组３７例，并进行平均４４月的追踪随访。随访内容为：每年重复做１次动态心电图，有无再次发生心肌梗塞、猝死或其它原因的死亡。结果：陈旧性心肌梗塞无症状心肌缺血组死亡１１例（占２７％），无心肌缺血ＳＴ段改变组死亡２例（占５％），二者差异非常显著（Ｐ＜０．００１）。作者认为无症状性心肌缺血是陈旧性心肌梗塞预后不良的危险因素之一，其原因可能与冠脉病变严重导致冠脉储备能力下降，以及心脏生理负荷重和心功能差等因素有关。积极有效地防治无症状性心肌缺血以降低病死率。

78 patients with old myocardiac infarction(OMI)were monitored by hoter,and according to thepresence or absence of the asym ptomatic ST segmentdepression,thc patients were randomly divided in to 2groups:the group with asymptomatic ST depresSion(41 cases)and the group without ST depression(37cases).The mean period of follow-up was 44months.To carify the effects of the asymptomaticmyocardia ischemia on the prognosis of OMI ,the re-sults of annual holter re-examination and the recur-rence of myocardiac infaction and sudden death or death due to other causes were recorded in the follow-up.The results showed that the death rate ofthe group with asym ptomatic ischemia bwas 27%(11/41),and that of the group without ischemiawas 5%(2/37).Statlsticaly,there was a very signifi-cant difference between the two groups(P<0.001).Itis considered that asymptomatic myocardial ischemia19 one of the risk factors in the poor prognosis ofOMI,Possibly,this is ralated to the followingfactors:the severe coronary artery lesion leading todecreased coronary blood reserve,increased psycho-logical and physiological loads,and heartdysfunction,It is suffested that aggressive and effec-tive prvention and treatment be given to the patientswith asymptomatic myocardial ischemia to decreasethe mortality.