Giri S, Thompson P D, Kiernan F J, Clive J, Fram D B, Mitchel J F, Hirst J A, McKay R G, Waters D D
Division of Cardiology, Hartford Hospital, Conn 06102, USA.
JAMA. 1999 Nov 10;282(18):1731-6. doi: 10.1001/jama.282.18.1731.
Vigorous physical exertion transiently increases the risk of acute myocardial infarction (MI), but little is known about the clinical characteristics of exertion-related MI.
To compare the clinical and angiographic characteristics of patients who had an exertion-related acute MI vs those who experienced an MI not related to exertion.
Prospective observational cohort study of patients with an acute MI referred to a tertiary care hospital for primary angioplasty.
Of 1048 patients with acute MI, 640 (64 who experienced an exertion-related MI and 576 who did not) were selected for treatment with primary angioplasty and admitted between August 1995 and November 1998.
Clinical characteristics of the patients, including their habitual physical activity (determined by the Framingham Physical Activity Index and the Lipid Research Clinic Physical Activity Questionnaire), angiographic findings during coronary angiography, and the relative risk (RR) of MI during exertion.
Patients who experienced exertion-related MI were more frequently men (86% vs 68%), hyperlipidemic (62% vs 40%), and smokers (59% vs 37%), were more likely to present with ventricular fibrillation (20% vs 11%), Killip classification III or IV heart failure (44% vs 22%), single-vessel disease (50% vs 28%), and a large thrombus in the infarct artery (64% vs 35%) and were more likely to be classified as having very low or low activity (84% vs 66%). The RR of experiencing an MI during exertion was 10.1 times greater than the risk at other times (95% confidence interval [CI], 1.6-65.6), with the highest risk among patients classified as very low active (RR, 30.5; 95% CI, 4.4-209.9) and low active (RR, 20.9; 95% CI, 3.1-142.1).
These results show that exertion-related MIs occur in habitually inactive people with multiple cardiac risk factors. These individuals may benefit from modest exercise training and aggressive risk-factor modification before they perform vigorous physical activity.
剧烈体力活动会短暂增加急性心肌梗死（MI）的风险，但关于运动相关心肌梗死的临床特征知之甚少。
比较运动相关急性心肌梗死患者与非运动相关心肌梗死患者的临床和血管造影特征。
对因急性心肌梗死转诊至三级护理医院进行直接血管成形术的患者进行前瞻性观察队列研究。
在1048例急性心肌梗死患者中，640例（64例经历运动相关心肌梗死，576例未经历）被选进行直接血管成形术治疗，并于1995年8月至1998年11月入院。
患者的临床特征，包括其习惯性体力活动（由弗雷明汉体力活动指数和脂质研究诊所体力活动问卷确定）、冠状动脉造影期间的血管造影结果以及运动期间心肌梗死的相对风险（RR）。
经历运动相关心肌梗死的患者男性比例更高（86%对68%）、高脂血症比例更高（62%对40%）、吸烟者比例更高（59%对37%），更易出现心室颤动（20%对11%）、Killip分级III或IV级心力衰竭（44%对22%）、单支血管病变（50%对28%）以及梗死相关动脉内大血栓（64%对35%），且更易被归类为极低或低活动水平（84%对66%）。运动期间发生心肌梗死的RR比其他时间的风险高10.1倍（95%置信区间[CI]，1.6 - 65.6），在被归类为极低活动水平的患者中风险最高（RR，30.5；95%CI，4.4 - 209.9），在低活动水平患者中风险次之（RR，20.9；95%CI，3.1 - 142.1）。
这些结果表明，运动相关心肌梗死发生在有多种心脏危险因素的习惯性不活动人群中。这些个体在进行剧烈体力活动之前，可能会从适度的运动训练和积极的危险因素调整中获益。
