再发心肌梗死的临床特点及其对一年预后的影响

The Characteristics and Influences of Recurrent Myocardial Infarction on 1 Year Clinical Outcomes

目的：探讨再发心肌梗死患者的临床特点及其对患者1年内临床预后的影响。方法：从2005年5月—2008年4月韩国急性心肌梗死注册（KAMIR）研究中入选10384例急性心肌梗死（MI）患者,根据病史分为初次MI组（n=9450）和再发MI组（n=934）。记录年龄、性别、心血管疾病危险因素（高血压、糖尿病、血脂异常）、吸烟、家族史、合并症、入院时生命体征、体质量指数（BMI）、心功能（KILLIP’s分级）、血常规、血脂、心肌酶、肾功能、左室射血分数（LVEF）等检查指标,基础用药及入院后治疗情况。记录患者通过门诊或电话随访的术后12个月时心血管不良事件（MACE）的发生情况。结果：再发MI患者年龄偏大,男性所占比例较高,具备心血管疾病危险因素者所占比例高,同时合并外周动脉疾病和脑血管疾病者居多（均P〈0.05）,患者入院时心功能较差（LVEF：0.4719±0.1167vs0.5121±0.1074;KILLIP’sⅢ-Ⅳ级比例：17.77%vs10.28%;均P〈0.05）。再发MI患者1年内总体心血管不良事件发生率明显高于初次MI患者（12.63%vs8.78%,P〈0.05）,全因死亡和心源性死亡比率均高于初次MI组（P〈0.01）。与初次MI相比,再发MI者发生MACE的OR为1.481（95%CI1.222-1.796,P〈0.05）,经校正年龄、性别、KILLIP’s分级、糖尿病、PCI成功等因素后,OR为1.409（95%CI1.114-1.782,P〈0.05）。结论：再发MI患者基础病情更加严重,且不容易得到充分再血管化治疗,1年内总体MACE发生率明显高于初次梗死患者,是一项独立危险因素。

Objective： To investigate the characteristics of recurrent myocardial infarction （MI） and the influence of prior MI on the clinical outcomes in patients with myocardial recurrent MI. Methods： The current data came from the Korea Acute Myocardial Infarction Registry （KAMIR） study, which consisted of 10 384 consecutive acute MI patients from May 2005 to April 2008. According to the medical history, patients were divided into two groups, the first MI group （n=9 450） and recurrent MI group （n=934）. The clinical data were recorded including age, gender, cardiovascular disease risk factors （hypertension, diabetes, dyslipidemia）, smoking history, family history, comorbidities, admission vital signs, body mass index （BMI）, heart function （KILLIP’s classification）, routine blood test, blood lipids, myocardial enzymes, renal function, left ventricular ejection fraction （LVEF） and medication. The occurrence of adverse cardiovascular events （MACE） in 12 months after operation, recurrent myocardial infarction and the clinical features, and their prognostic impact in one year were recorded by clinic or telephone follow-up. Results： Patients were older in recurrent MI group than those in the first MI group. A high proportion of men,a high proportion of those with cardiovascular disease risk factors and those with combined peripheral？arterial diseases？and cerebrovascular？diseases were found in recurrent MI group （P 〈 0.05）. The？poor cardiac functions were found in patients at admission with LVEF 0.471 9±0.116 7 vs 0.512 1±0.107 4 and 17.77% vs 10.28% of KILLIP’s Ⅲ-Ⅳ（P 〈 0.05）. The incidence of major adverse cardiovascular events was significantly higher in patients with recurrent MI than that of patients with the first MI （12.63% vs 8.78%,P 〈 0.05）. Compared with patients with the first MI, OR was 1.481（95% CI 1.222-1.796,P 〈 0.05） in patients with recurrent MI. After adjusting for age, gender, KILLIP’s grade, diabetes and percutaneous？coronary intervention？（PCI） treatment, OR was 1.409 （95%CI 1.114-1.782, P 〈 0.05）. Conclusion： Patients with recurrent MI presented with worse baseline characteristics and more severe coronary artery conditions, which might lead to insufficient revascularization and relate to a higher risk of MACE in 1year follow-up.