急性心肌梗死后卡托普利早期和长期治疗五年随访结果

A five years follow up study of early and long term treatment of captopril in patients with acute myocardial infarction

目的 急性心肌梗死（心梗） 后５ 年随访期间比较各种因素对死亡率影响，探讨卡托普利早期长期治疗的预后意义。方法 ８２２ 例首次急性心梗后７２ 小时内入院且无心源性休克患者中，４７８ 例早期并长期持续应用卡托普利和常规治疗（ 治疗组） ，３４４ 例仅常规治疗（ 对照组） 。用Ｃｏｘ 回归方法作多因素分析，ＫａｐｌａｎＭｅｉｅｒ法分析两组随访期累积生存率和心源性事件发生率。结果 年龄、Ｋｉｌｌｉｐ 分级（ ≥Ⅱ级）、前壁梗死、糖尿病、ＣＰＫ高峰浓度相对危险性＞１ ，卡托普利、β受体阻滞剂、血小板拮抗药和静脉溶栓相对危险性＜ １ 。治疗组随访各阶段累积生存率高于对照组（ Ｐ＜ ０．００１） ，心源性事件累积发生率低于对照组（ Ｐ＜ ０ ．０００１）。结论 早期长期卡托普利治疗急性心肌梗死患者对其预后具有益作用。

Objective To investigate the influence of early and long term treatment of captopril in patient with acute myocardial infarction (AMI) during a five years follow up. Methods In a randomized trial, 822 patients with first episode AMI, less than 72 hours after admission were treated with captopril (treatment group, n=478, 6.25 mg increased to 25mg 3次/d) and conventional treatment (control group, n=344). Used mutivariable COX regression to analyze the relative risk of independent variables. Cumulative survival and cardiac events of both groups were calculated by Kaplan Meier analysis and log rank comparision.Results During the five years follow up, age, Killip staging (≥Ⅱ), anterior infarction, diabetes mellitus and peak CPK levels were found to increase the relative risk of death after AMI, but the relative risk of death by captopril, β blocker, antiplatelet drug or thrombolytic therapy was on the contrary. The cumulative survival in different follow up periods was higher in patients with captopril than that of controls group ( P <0.001), but the cardiac events was lower ( P <0.0001). Conclusion Early and long term treatment of captopril is beneficial in improving the outcome after AMI. (Shanghai Med J, 2000,23∶23 26)