急性心肌梗死并发心房颤动/心房扑动对近、中期预后的影响

Effects of atrial fibrillation/atrial flutter on the short and medium-term prognosis of patients with acute myocardial infarction

目的评价急性心肌梗死(AMI)并发心房颤动(房颤)/心房扑动(房扑)对患者近、中期临床预后的影响。方法2001年1月至2005年12月确诊的AMI患者297例,分为房颤/房扑动组(33例)和无房颤/房扑组(264例)。比较两组30d及6个月内病死率、Killip分级、心源性休克、心律失常发生情况。以多普勒心脏超声测定患者AMI后6个月的左室射血分数(LVEF)。结果房颤/房扑组与无房颤/房扑组比较:年龄大、CPK峰值高、心源性休克率高、既往发生过心肌梗死者比例高、入院时心功能Killip分级Ⅰ级比例低,多支血管病变率高,LVEF<40%比例高(P<0.05);与无房颤/房扑组比较,房颤/房扑组30d内及6个月病死率、心源性休克、恶性室性心律失常、再发心肌缺血率、再梗死率明显增高(P<0.05);二组LVEF比较差异有统计学意义(P<0.05)。结论AMI并发房颤/房扑的患者其近中期病死率明显增加。

Objective To evaluate the influnce of atrial fibrillation（AF）/atrial flutter on the mortality and prognosis of patients with AMI. Methods A total of 297 consecutive patients were studied from Jan.2001 to Dec. 2005 and were categorized into 2 groups according to the presence or absence of AF/atrial flutter. The 30 d and 6 mo mortalities, Killip Grades, cardiogenic shock, arrhythmia and left ventricular ejectory functional （LVEF） 6 months after AMI with Doppler US between the 2 groups were compared. Results The incidence of AF/atrial fluttler was 12.5% with older age, higher Killip Gorade, higher CPK peak, higher rates of previous myocardial infarction and multivascular involvement than those without AF/atrial flutter. The short and medium-term mortalities in AF/atrial flutter group were both significantly higher than those of non-AF/atrial flutter group（P〈0.05）. Conclusions The short and medium-term mortalities increase obviously in AMI complicated with AF/atrial flutter, probably related to the severity of atherosclerosis.