卡托普利治疗对急性心肌梗塞二级预防的作用

BeneficialefectsofcaptoprilonprognosisinpatientswithacutemyocardialinfarctionShanghaiSecondaryPreventionofAcuteMyocardialInfarctionStudyGroup

８２２例首次急性心肌梗塞症状后７２小时内入院且无心源性休克患者中，４７８例自入院后开始并于随访期持续接受常规及卡托普利治疗（甲组），３４４例单纯接受常规治疗（乙组）。住院期间中，甲组病死率（６．９％）明显低于乙组（１８％）（Ｐ＝０．００１），且心肌梗塞前壁或（和）下壁具相似作用（前壁：６．８％和１８．３％，Ｐ＜０．００１；下壁：６．４％和１３．５％，Ｐ＜０．０５；前壁＋下壁：１０．７％和３９．２％，Ｐ＜０．０３）。随访期（平均２０个月）中，尽管两组再梗塞和严重心律失常发生率相似，但甲组的病死率（２．３％和１６．２％，Ｐ＝０．０３２４）和总心脏性事件发生率（１０．３％和３７．４％，Ｐ＝０．０５５）显著低于乙组。因此，急性心肌梗塞后早期并持续应用血管紧张素转换酶抑制剂－卡托普利治疗对患者的预后具有益作用。

Objectives:Toassesstheefectsofearlyandlong-termangiotensin-convertingen-zymeinhibitortreatmentwithcaptoprilonclinicaloutcomeafteracutemyocardialinfarction(AMI).Methods:EighthundredandtwentytwopatientswithAMIwhowerehospitalizedwithin72hoursofsymptomsandhadnocardiogenicshockwererandomlyalocatedtocaptopril(groupⅠ,n=478)andconventionaltreatment(groupⅡ,n=344).Cardiaceventsincludingcongestiveheartfailure,rein-farction,severearrhythmiasandcardiacdeathduringhospitalizationandfolow-upperiod(average20months)weredetermined.Results:TheoveralmortalityrateduringhospitalizationwasloweringroupⅠ(6.9%)thaningroupⅡ(18%)(P=0.0324);thiswastrueforpatientswithanterior(6.8%vs18.3%,P=0.0003),inferior(6.4%vs13.5%,P=0.0411)andanteriorplusinferiorAMI(10.7%vs39.2%,P=0.0232).Duringfolow-up,despitesimilarocurrencerateofreinfarc-tionandseverearrhythmiasinthetwogroups,themortalityrate(2.3%vs16%,P=0.0324)andtotalcardiaceventrate(10.3%vs37.4%,P=0.055)wereloweringroupⅠthaningroupⅡ.Con-clusions:AfterAMI,earlyandlong-termtreatmentwithcaptoprilexertsabeneficialefectontheprognosisofpatients.