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 1988～ 1995年急性心肌梗死患者中选出住院期间作过冠状动脉造影的患者 112例进行随访研究。结果 (1)寿命表推测 ,10 %的患者在急性期死亡 ,2 0 %在心肌梗死后 5～ 10年内死亡 ;(2 ) 2 4 5 %的患者在随访期间发生严重的心绞痛或是严重的左心功能不全 ;(3)再通治疗方法 (溶栓治疗 ,PTCA) ,再通的效果 (梗死相关动脉开通 ,急诊开通 ) ,血管病变和缺血程度的因素在死亡和生存两组间差异无显著性 ,P >0 0 5 ;左心室功能的因素 ,如曾经发生过左心衰竭 ,急性期LVEF ,随访期的左室舒张末内径和LVEF ,心功能NYHA分级在两组间差异有显著性 ,P分别为 <0 0 5或 <0 0 0 1;(4 )再通的效果 ,血管病变支数 ,缺血范围和再梗死在严重心绞痛组和非严重心绞痛组两组间 ,在严重左心功能不全组和非严重左心功能不全组之间差异有显著性 ,P <0 0 5 ;部分左心室功能的因素 ,随访期左室舒张末内径和左室射血分数 ,心功能NYHA分级差异亦有显著性 ,P分别为 <0 0 5或 <0 0 0 1;(5 )随访期左室舒张末内径明显增大 ,左室射血分数明显下降 ,差异有显著性 ,P <0 0 5。结论 再灌注治疗使更多的患者渡过了急性缺血期 ,但患者出院后可能死于再梗死、左心衰、猝死 ;

Objective To analyze the risk factors for long-term prognosis in patients with acute myocardial infarction (AMI). Methods One hundred and twelve patients who underwent coronary angiography and echocardiography during hospitalization from 1988-1995 were followed. The investigation was carried out mainly by seeing the patients at the outpatient clinic. The patients 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 during the follow-up. If the patients were unable to come to the hospital, the investigator would ring the patients or their family. Results (1) Life table showed that 10% of the patients 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) 24.5% of patients developed severe angina or heart failure; (3) LV dysfunction were significant risk factors for death (P<0.05-0.001),while coronary angiographic factors were not. (4) Both the LV dysfunction and coronary angiographic factors were correlated closely with severe angina and heart failure(P<0.05-0.001). (5) LVED increased and LVEF decreased significantly during the follow-up, P<0.05. Conclusion Even if patients survive from AMI, they continue to experience the chronic processes of coronary atherosclerosis and LV function deterioration. Patients may die of re-infarction, heart failure or malignant arrhythmias. They may develop angina or heart failure. LV dysfunction is the most important risk factor for death. Ischemia and LV dysfunction are interrelated, and share the same risk factors. To prevent LV dysfunction early reperfusion and medical treatment directing at LV remodeling, neurohormonal abnormality and apoptosis, seem to be important and appropriate.