DCG检出的老年人无症状性心肌缺血的远期预后

Long-term prognostic significance of silent myocardial ischemia detected by routine dynamic electrocar- diography in the elderly

对在我院进行体检的老干部常规进行DCG检查,701例中,有心肌缺血发作者108例(15.4%),其中99例(91.7%)为完全无症状性心肌缺血.经过平均37月随访,此108例中发生急性心肌梗塞17例(15.7%),心性死亡16例(5.6%);而无心肌缺血者593例中,发生急性心肌梗塞17例(2.9%),心性死亡5例(0.8%).总心肌缺血时间<60min者54例中,发生急性心肌梗塞4例(7.4%),心性死亡1例(1.9%).总心肌缺血时间≥60min者54例中,发生急性心肌梗塞13例(24.1%),心性死亡5例(9.3%).说明老年人无症状性心肌缺血是常见的且有显著的远期预后意义.

The long-tenn prognostic significance of silent myocar-dial ischemia detected by routine dynamic electrocardiogram (DCG) in the elderly was assessed. 108(15. 4 % ) out of 701 cases were diagnosed to have myocardial ischemia, 99 of whom (91. 7%) were completely silent. Of the 1393 episodes. 1353(97. 1%) were silent. During a mean follow-up period of 37 months there were 34 AMI (17 with and 17 without myocardial ischemia) deaths (6 with and 5 without myocardial ischemia). The incidence of AMI was 15.7% (17/108) in patients with myocardial ischemia and 2. 9% (17/593) in those without ( P <0. 01). The incidence of cardiac death was 5. 6% (6/108) in patients with myocardial ischemia and 0. 8% (5/593) in those without ( P <0. 01). The incidence of AMI was 7. 4%(4/54) in patients with total ischemia time (TIT) <60 minutes and 24.1% (13/ 54) in patients with TIT≥60 minutes( P <0. 01). The incidence of cardiac death was 1. 9% (1/54) in patients with TIT<60 minutes and 9. 3% (5/54) in patients with TIT≥60 minutes ( F <0. 01). The results above suggested myocardial ischemia (mainly silent) was common and had significant prognostic value, especially when TIT≥60 minutes.