梗塞前心绞痛对老年急性心肌梗塞预后的影响

Prognostic effect of angina before acute myocardial infarction in elderly patients

目的 :为了研究梗塞前心绞痛 (AP)对老年急性心肌梗塞 (AMI)预后的影响。方法 :作者对 186例AMI患者 (老年人 118例 ,老年前期 68例 ) ,观察AMI前 4 8h有无AP发作 ,分为AP(+ )和AP(- )组 ,分析两组病人的预后。结果 :在 <60岁的AMI患者中 ,梗塞前AP可降低AMI患者 1月内充血性心衰 (CHF)、心源性休克和心源性死亡率 (P<0 .0 1) ;CK峰值降低 ,达峰时间缩短 (P <0 .0 1) ;高危性室性心律失常 ,高度房室传导阻滞 (AVB)及左室射血分数(LVEF)≤ 3 5 %者均减少 (均P <0 .0 5 )。在老年患者中 ,AMI前有AP发作和无AP发作者 1月内CHF、心源性休克和心源性死亡率比较无统计学差异 (P >0 .0 5 ) ;无AP发作者CK峰值显著升高 (P<0 .0 1) ;广泛前壁心梗和高度AVB者增多 (P <0 .0 5 ) ;随访中 ,远期心源性死亡率增加 (18 0 %vs 5 .9% ;P <0 .0 5 )。结论 :梗塞前心绞痛能改善AMI的预后。

Objective: The present study examined whether angina 48?h before acute myocardial infarction provided protection in early and adult patients. To investigate the effect of ischemic preconditioning in senescent heart. Methods: We retrospectively verified whether antecedent angina within 48?h myocardial infarction exerted a beneficial effect on in hopsital outcomes in adult(<60 years old, n=68) and elderly (≥60 years old, n=118) patients. Results: In hospital congestive heart failure was more frequent in adult patients without than in those with previous angina(16.7% vs 2.6%, P<0.05), as were cardiogenic shock and death(23.3% vs 5.3%, P<0.05) and the combined end points(in hospital congestive heart failure and shock or death)(40.0% vs 7.9%, P<0.01). In contrast, the presence or absence of previous angina before acute myocardial infarction in elderly patients seemed to have no obvious influence, the incidence of in hospital congestive heart failure(17.7% vs 20.0%, P>0.05), shock and death(23.5% vs 20.3%, P>0.05) and combined end points(41.2% vs 40.0%, P>0.05). But the elderly patients with angina showed a significantly smaller infarct size compared with elderly patients without angina, the long term cardiogenic death was more frequent in elderly patients without than in those with previous angina(18.0% vs 5.9%, P<0.05). Conclusions: The presence of angina before acute myocardial infarction seems to confer significant protection aganist in hospital outcomes in adults; this effect seems to be present in elderly patients. This study suggests that the protection afforded by angina in adult and elderly patients may involve the occurrence of ischemic preconditioning. [