心肌梗死前心绞痛对心肌梗死后近远期心功能的影响

Influence of pre-infarction angina on left ventricular function in patients with myocardial infarction

目的:探讨梗死前心绞痛对心肌梗死左室功能的影响。方法:129例首次AMI患者,按既往有无梗死前心绞痛分为3组:A组44例,梗死前无心绞痛史;B组40例,梗死前1个月内有心绞痛,且梗死前48h内至少有一次典型心绞痛发作;C组45例,梗死1个月前有心绞痛;监测心肌梗死后12～19个月的左室功能。结果:①C组患者双支以上血管病变多于A组和B组(P<0.05);②CK-MB峰值水平B组患者低于A组患者和C组患者(P<0.01);③组内比较,所有患者LVDd均降低(P<0.05),B组患者LVEF增高(P<0.01),A组和B组患者E/A增高(P<0.05);组间比较,B组患者LVEDd低于A组(P<0.05),B组患者LVEF、E/A均高于A组和C组患者(P<0.01);④于3组患者中,梗死后主要心脏事件(除外严重心律失常)B组最少,C组最多(P<0.05～<0.01)。结论:梗死前1个月内心绞痛可保护梗死后近期与远期左心室功能、降低梗死后心脏事件发生率。

Objective： To explore the effects of pre-infarction angina on left ventricular function in patients with myocardial infarction （MI）. Methods： A total of 129 patients with first acute myocardial infarction were randomly divided into three groups according to pre-infarction angina： group A （without pre-infarction angina, 44 cases）, group B （with pre-infarction angina within 1 month, 40 cases）, group C （with pre-infarction angina more than 1 month, 45 cases）. The changes of left ventricular function were monitored during 12-19 months after acute episode. Results：①the incidence of multi-vessel angiographic lesion of group C were higher than those of group A and B （P〈0.05） ; ② The CK-MB peak level of group B was lower than those of group A and C （P〈0. 01） ;③Within group： left ventricular end-diastolic diameter （LVEDd） in all the patients were decreased （P〈0.05）, LVEF of group B was improved （P〈0.01）, E/A of group A and B were improved （P〈0.05） ; between group： LVEDd in group B was lower than that in group A （P〈0.05）, LVEF and E/A in group B were higher than those in group A and C （P〈0.01）; ④The major adverse cardiac events （MACE） （except severe arrhythmia） of group B was least, and of group C was maximum （P〈0.05 - 〈0.01） in three groups. Conclusion： Pre-infarction angina within 1 month can protect left ventricular function long time and decrease the incidence of MACE.