卡托普利对老年人急性心肌梗死的治疗及二级预防的作用

Beneficial effects of captopril on the treatment and secondary prevention of acute myocardial infarction in elderly

目的探讨老年人急性心肌梗死（心梗）卡托普利治疗对预后的意义。方法６３１例首次急性心梗后７２小时内入院无心源性休克老年患者中，３６１例早期及随访期持续卡托普利治疗（治疗组），２７０例常规治疗（对照组），比较两组住院期和随访期生存率的差异。结果住院期治疗组生存率（９２．２％）显著高于对照组（７８．９％，Ｐ＜０．００１），卡托普利对前壁心梗作用较下壁心梗明显。随访期（第９周～第５４个月末）第５４个月末治疗组累积生存率（９１．０％）显著高于对照组（７４．０％，Ｐ＜０．０１），心源性事件累积发生率（５５．０％）低于对照组（７２．０％，Ｐ＜０．０００１）。

Objective To investigate the effects of captopril on early and longterm intervention of acute myocardial infarction (AMI) in elderly. Methods Six hundred and thirtyone AMI elderly patients(6075 years old) without cardiogenic shock hospitalized within 72 hours of symptoms were randomly allocated to captopril treatment group (n=361), and conventional treatment as controls (n=270). The survival and cardiac events in both groups were observed in hospital and during followup (54 months). Results In the captopril treatment group the survival was higher (922%) than in controls (789%,P<0001) and more marked for the patients with anterior MI (P<0001) than those with inferior MI (P>005). Higher cumulative survival (910% vs. 740%,P<001) but lower total cumulative cardiac events (550% vs. 720%,P<0001) were seen in treatment group during followup. Conclusions Early and longterm treatment with captopril in the elderly patients with AMI has beneficial outcomes in hospital and during followup.