Altun A, Ozçelik F, Ozkan B, Ozbay G
Department of Cardiology, Trakya University, School of Medicine, Edirne, Turkey.
Coron Artery Dis. 1999 Oct;10(7):455-8.
Inferior acute myocardial infarctions (AMI) have better in-hospital prognosis than do anterior AMI. Authors of several studies reported that patients with inferior AMI complicated by atrioventricular block, concomitant precordial ST-segment depression and involvement of right ventricle have larger infarctions and a worse prognoses than do patients without these features.
To analyse the incidence, clinical course and in-hospital prognosis of patients with heart failure and first inferior AMI.
We analysed in 257 consecutive patients with first inferior AMI who had been admitted to the coronary care unit during January 1991 and March 1995. The clinical and electrocardiographic characteristics, as well as the morbidities and in-hospital mortalities, of groups of patients with and without heart failure during inferior AMI were compared.
Symptoms and signs of heart failure were noted for 49 patients (19%). We found that patients who had suffered heart failure during inferior AMI were older (62.1 +/- 9.86 versus 58.78 +/- 10.58 years, P < 0.05) than those who had not suffered heart failure. There was no significant difference between patients' sex, history of diabetes mellitus, hypertension, smoking status, thrombolytic therapy, involvement of right ventricle and QRS score for these two groups. We found a greater prevalence of ST-segment depression (ST-segment depression > or = 1 mV in more than one precordial lead with maximal ST-segment depression in leads V4-V6) of V4-V6 precordial leads (57 versus 26%, P = 0.00002) and a lesser prevalence of no ST-segment depression (ST-segment depression < 0.1 mV in each precordial lead; 14 versus 38%, P = 0.001) among patients who had suffered heart failure. We found greater incidences of serious ventricular arrhythmias (53 versus 26, P = 0.0002) and ventricular tachycardiafibrillation (16 versus 7%, P = 0.03) among patients who had suffered heart failure than we did among those who had not. Third-degree atrioventricular block was more often found in patients who had suffered heart failure (23 versus 12%, P = 0.07) but this difference was not statistically significant. We found that the in-hospital mortality among patients who had suffered heart failure was much higher than that among those who had not (24.5 versus 3.8%, P = 0.000001).
We found that heart failure occurs primarily in old patients, and in those with precordial ST-segment depression, especially in leads V4-V6. The patients who suffer heart failure have worse in-hospital prognosis due to serious ventricular arrhythmias and cardiogenic shock.
下壁急性心肌梗死（AMI）患者的院内预后优于前壁AMI患者。多项研究的作者报告称，合并房室传导阻滞、伴有胸前导联ST段压低及右心室受累的下壁AMI患者，梗死面积更大，预后比无这些特征的患者更差。
分析心力衰竭合并首次下壁AMI患者的发病率、临床病程及院内预后。
我们分析了1991年1月至1995年3月期间连续收治入冠心病监护病房的257例首次发生下壁AMI的患者。比较了下壁AMI期间发生和未发生心力衰竭患者组的临床和心电图特征，以及发病率和院内死亡率。
49例患者（19%）出现心力衰竭的症状和体征。我们发现，下壁AMI期间发生心力衰竭的患者年龄（62.1±9.86岁 vs 58.78±10.58岁，P<0.05）比未发生心力衰竭的患者更大。两组患者的性别、糖尿病史、高血压史、吸烟状况、溶栓治疗、右心室受累情况及QRS评分无显著差异。我们发现，下壁AMI期间发生心力衰竭的患者中，V4-V6胸前导联ST段压低（V4-V6导联中多个胸前导联ST段压低≥1mV且V4-V6导联ST段压低最大）的发生率更高（57% vs 26%，P=0.00002），无ST段压低（每个胸前导联ST段压低<0.1mV）的发生率更低（14% vs 38%，P=0.001）。我们发现，下壁AMI期间发生心力衰竭的患者严重室性心律失常（53% vs 26%，P=0.0002）和室性心动过速/心室颤动（16% vs 7%，P=0.03）的发生率高于未发生心力衰竭的患者。三度房室传导阻滞在发生心力衰竭的患者中更常见（23% vs 12%，P=0.07），但这种差异无统计学意义。我们发现，发生心力衰竭的患者院内死亡率远高于未发生心力衰竭的患者（24.5% vs 3.8%，P=0.000001）。
我们发现心力衰竭主要发生在老年患者及胸前导联ST段压低的患者中，尤其是V4-V6导联。发生心力衰竭的患者因严重室性心律失常和心源性休克，院内预后更差。
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