梗死前心绞痛病程时间对急性ST段抬高心肌梗死远期预后的影响

Effects of Different Courses of Preinfarction Angina on the Long-Term Prognosis in Patients with First Acute ST-segment Elevated Myocardial Infarction

目的:通过分析研究300例有梗死前心绞痛病史患者的临床资料,探讨梗死前心绞痛病程时间对急性ST段抬高心肌梗死远期预后的影响。方法:连续性收集326例初发急性ST段抬高心肌梗死(ASTEMI)患者临床资料。对上述病例随访,平均随访(31.05±14.26)月,共随访到300例,随访率92.02%。对300例患者根据梗死前心绞痛病程时间分组:长期心绞痛组(简称A组):AMI前AP病史≥30天,共151例;近期心绞痛组(简称B组);7天≤AMI前AP病史<30天,共33例;短期心绞痛组(简称C组):AMI前AP病史<7天,共116例。对3组病例进行回顾性分析,比较各组一般临床资料、远期预后(并发症及近、远期主要不良心脏事件发生率)。结果:A组病例再入院(由于心脏原因)、再次心肌梗死、随访期间及总的心源性死亡发生率显著高于C组(P<0.01),B组与A、C组间上述各指标无显著差异(P>0.05)。随访期间,3组首次心梗后存活病例的累积死亡例数呈上升趋势,随访时间达3、4、5年时,A组与C组累积死亡率均有显著统计学差异。Kaplan-Meier生存曲线显示:3组病例AMI后累积生存率呈逐渐下降趋势,A、B组生存曲线分别在AMI后4、9个月下降较明显,C组生存曲线在6个月后缓慢下降,36个月时明显下降,以后下降均较平缓。首次心梗后未接受PCI治疗是初发ASTEMI死亡的独立预测因素。结论:梗死前长期心绞痛患者ASTEMI后远期预后较差,表现为再入院率、再次心肌梗死率、随访期及总心源性死亡率显著高于短期心绞痛组。首次心梗后接受PCI治疗是ASTEMI患者累积生存率的独立预测因素,未接受PCI治疗患者的心源性死亡危险升高。

Objective：To explose the effects of different course of preinfarction angina（PA）on long-term prognosis in patients with first acute ST-segment elevated myocardial infarction（ASTEMI）,through the study of clinical materials for 300patients with preinfarction angia.Method：All 326 patients with first acute ST-segment- elevated myocardial infarction （ASTEMI）,were hospitalized and followed up consecutively.An average period of followed up time is （31.05±14.26） months.The following up rate was 92.02% and 300 patients were enrolled.All300 patients were assigned to three groups according to different course of PA history：1. Long-term PA group （abbreiated as group A）：PA history more than 30 days （151 patients）;PA history less than 7 days （116 patients）;2. Medium-term PA group （abbreviated as group B）：PA history more than 7 days and less than 30 days（33 patients）;3.Short-term PA group （abbreviated as group C）. The short and long-term prognosis （complication,short and long-term incidence of major adverse cadiac event） were compared retrospectively.All of these data underwent statistics test by SAS8.12 software,P〈0.05 should be thought as the significant difference in statistics.Results：In group A, the incidence of readmission（for cardiac reason）,recurrent AMI,follow-up and total cardiogenic mortality were higher than that in group C（P〈0.01）.In group B,those indexes were not significantly different with other two groups （P〉0.05）.The cumulative death cases who survived initial AMI presented the upward trend among three groups during the period of follow-up.When the follow-up time reached 3rd,4th and 5th years,thd cumulative mortality had remarkable statictical discrepancy between group A and group C.Kaplan-Meier＇s survival curve showed that the cumulative survival rate of three groups presented downward trend.The survival curve of group A and B declined obviously after four,nine months respectively.The survival curve of group C declined gradually after six months and declined obviously after thirty-six months.Not accepting PCI was an independent prognostic factor of death after first ASTEMI.Conclusions：In the long-term PA group,the long-term prognosis was relatively worse,the incidence of readmission,recurrent AMI,follow-up and total cardiogenic mortality was higher than that in the short-term PA group.Accepting PCI was an independent prognostic factou of cumulative survival rate after first ASTEMI,the risk of cardiac death was rising for patients not accepting PCI.