急性心肌梗死长期随访结果——预后影响因素的分析

Long-term follow-up of acute myocardial infarction: risk factors for long-term prognosis

目的 :分析影响急性心肌梗死长期预后的因素。方法 :从 19881995年急性心肌梗死患者中选出住院期间做过冠状动脉造影的患者 91例 ,进行随访调查。结果 :①约 10 %的患者在急性期死亡 ,10 %在梗死后 5 6年死亡 ,约 10 %在 5 10年内死亡 ,10年的生存率约为 70 % ;②急性期梗死相关动脉 (IRA)未能开通 ,吸烟 ,曾经发生过左心衰 ,急性期LVEF ,心功能NYHA分级在生存和死亡两组有显著差异 ,P值分别 <0 0 5或 <0 0 0 1。③ 72例患者进入随访 ,19例曾经发生过 3级以上的劳力型心绞痛 ,或不稳定型心绞痛 ,占 2 6 4% ;梗死相关动脉是否开通 ,随访期间左室射血分数 (LVEF) ,NYHA分级在发生与未发生严重心绞痛两组间有明显的差别 ,P <0 0 5或 0 0 0 1,病变血管支数接近显著 ,P =0 0 6。④ 11例发生严重的心功能不全 ,占 15 3 % ,梗死相关动脉是否开通 ,急性期左室射血分数 (LVEF)和左室舒张末内径 (LVED) ,加拿大心脏学会心绞痛分级 (CNC)在发生与未发生严重心功能不全两组间差异显著 ,P <0 0 5 ;⑤随访期LVED明显增大 ,LVEF明显下降 ,差异显著 ,P <0 0 5。结论 :早期IRA的开通可以明显降低死亡率 ,但急性期后的死亡与冠状动脉病变程度和范围关系不密切 ,而主要与左心功能有关 ,急性左心衰肺水肿 。

Objective: To analyze risk factors for long term prognosis in pts with AMI.Methods:Ninety one pts who underwent coronary angiography and echocardiography during hospitalization from 1988~1995 were followed The investigation was carried out mainly by seeing the pts at outpatient clinic The pts or their family were carefully asked about any major cardiac events occurring after the first AMI, which included death, non fatal AMI, revascularization procedures, heart failure, and severe angina Echocardiography was repeated at the follow up If the pts were unable to come to the hospital, the investigator would ring the pts or their family.Results:1. Fifteen pts (20 8%) died at the end of 10 year follow up Life table showed that 10% of the pts died in the acute phase of AMI, 10% died within 5~6 years, and 10% died 5~10 years The 10 year survival rate was about 70% 2 Smoking, acute heart failure, LVEF in acute phase , LV end diastolic diameter(LVED) at the follow up, NYHA class were significant risk factors for death, P <0 05 or 0 001 3 The patency of infarct related artery(IRA), LVEF at the follow up, NYHA class were significant risk factors for severe angina(≥3 CCS class), P <0 05 or 0 001 The number of diseased vessel was close to significance ( P =0 06) 4 IRA patency, LVEF and LVED in acute phase, CCS class were significant risk factors for severe left heart failure(NYHA class ≥3), P <0 05 5 LVED increased and LVEF decreased significantly during follow up, P <0 05. Conclusion:IRA patency, LVEF, LVED, NYHA class, CCS class are important determinants of long term prognosis LV function deteriorates significantly after the acute phase.