预测首次急性心肌梗塞患者心性意外的心血管造影因素

ANGIOGRAPHIC PREDICTION OF CARDIAC EVENTS AFTER THE FIRST ATTACK OF ACUTE TRANSMURAL MYOCARDIAL INFARCTION_2 A PROSPECTIVE STUDY OF 108 PATIENTS

本文对108例首次急性穿壁性心肌梗塞患者(年龄≤70岁)于发病后平均—个月行左心室及冠状动脉造影,并作临床随诊(平均22月)。多因素分析发现,左心室收缩末期容量≥100ml,舒张末期容量≥175ml及多支冠状动脉病变对预后有明显预测价值。

One hundred and eight hospital survivors of acute myocardial infarction (AMI), aged 70 years or younger, with a mean duration after infarction of one month, underwent left ventriculography and coronary arteriography and were followed up to a mean of 22 months (ranged 5～47 months). Evaluation of the contribution of angiographic variables to cardiac avent (death, recurrent infarction, coronary artery bypass grafting or congestive heart failure) was done by Kaplan-Meier survival curve analysis and log-rank test. Patients with cardiac events had left ventricular dilation, systolic dysfunction, multivessel coronary disease and lack of residual flow to the infarct region. Multivariate analysis showed that left ventricular end-systolic volume (P<0.001), end-diastolic volume (P<0.01) and number of diseased coronary vessels (P<0.05) were significant predictors of the outcome. This prospective study indicates that in survivors of the first transmural AMI undergone cardiac catheterization one month after the infarction, important additive prognostic information could be obtained.