卒中后急性心肌梗死患者临床特点和近期预后的分析

Analysis of dinical characteristics and short-term prognosis in patients with acute myocardial infarction after stroke

目的评价既往具有卒中病史的患者出现急性心肌梗死的临床特点、住院期间不良事件和病死率。方法纳入1994年1月—2006年12月初发心电图ST段抬高的心肌梗死患者1233例,其中男901例,女332例,按照是否有卒中病史分为卒中组(158例)和对照组(1075例),比较两组患者的临床特点、危险因素、住院并发症和病死率。结果①与对照组相比,卒中组患者年龄大,不典型症状多,发病至就诊时间长,接受再灌注治疗的比例较低,差异均具有统计学意义,P<0.05;②主要危险因素比较后,卒中组的高血压(69.7%)、糖尿病(30.3%)患者比例高于对照组(43.4%和14.5%),吸烟比例(41.0%)低于对照组(50.5%),差异有统计学意义,P<0.05;③卒中组与对照组比较住院期间急性脑血管事件(3.0%对0.8%)、心房颤动(6.5%对2.5%)、室性心动过速(3.2%对1.0%)、心力衰竭(42.9%对22.9%)和病死率(17.6%对9.5%),差异有统计学意义,P<0.05;④对死亡原因进行分析,卒中组因呼吸衰竭死亡的比例高于对照组(14.2%对2.9%),因心脏破裂死亡的比例低于对照组(14.3%对34.3%),差异均有统计学意义,P<0.05。结论卒中后急性心肌梗死患者的年龄大,危险因素较多,接受再灌注治疗的比例较低,住院期间更易出现并发症,临床工作中应高度重视。

Objective To evaluate the clinical characteristics, in-hospital adverse events, and mortality in patients with acute myocardial infarction and with a prior history of stroke. Methods A total of 1233 patients （female 332, male 901 ） with first attack of ST-segment elevation myocardial infarction were included in this study in our hospital from January 1994 to December 2006. They were divided into two groups according to with or without prior history of stroke. The clinical characteristics, risk factors, in-hospital complications, and mortality of the two groups were compared. Results ①Compared to the control group, the age of patients in the stroke group were older, with more atypical symptoms, longer time from the onset to treatment, and fewer patients received reperfusion treatment. There were all significant statistical differences; ②In comparing the major risk factors, the proportion in patients with hypertension （69.7% vs. 43.4% ） and diabetes （30.3% vs. 14.5% ） in the stroke group were higher than those in the control group, and the proportion of smoking （41.0% vs. 50.5% ） was lower than that in the control group. There were all significant statistical differences; ③there were more acute cerebrovascular events （3.0% vs. 0.8% ）, atrial fibrillation （6.5% vs. 2.5% ）, ventricular tachycardia （3.2% vs. 1.0% ）, heart failure （42.9% vs. 22.9% ）, and mortality （17.6% vs. 9.5% ） in the stroke group than those in the control group during hospitalization. There were all significant statistical differences;④Analysis of the causes of death, the proportion of respiratory failure caused mortality（ 14.2% vs. 2.9% ） in the stroke group was higher than that in the control group. The cardiac rupture caused mortality（ 14.3% vs. 34.3% ） was lower than that in the control group. There were all significant statistical differences （all P 〈 0 .05 ）. Conclusions The age of patients with acute myocardial infarction after stroke are elder, have more risk factors and fewer patients received reperfusion treatment are more likely to have in-hospital complications. These should pay more attention in the clinical practice.