溶栓治疗对首次急性心肌梗死后十二个月预后的影响。

Thrombolytic therapy impact on prognosis after twelve months of first acute myocardial infarction.

作者信息

Caires G, Pereira D, Freitas A D, Teixeira F, Leite R, Araújo J J, Cardoso A, Pereira A C, Macedo M E, Diniz M

机构信息

Departamento de Cardiologia Médico-Cirúrgica-Centro Hospitalar do Funchal Registo de Cardiopatia Isquémica da Madeira (RECIMA).

出版信息

Rev Port Cardiol. 2000 Nov;19(11):1103-19.

PMID:11201627

Abstract

INTRODUCTION AND OBJECTIVES

Thrombolytic therapy is still widely used to restore antegrade flow in the infarct related artery (IRA), with unquestionable benefits in mortality reduction of such patients. The aim of this study was to evaluate early (< or = 28 days) and one-year mortality of patients with a first Q wave myocardial infarction (Q AMI), comparing those who underwent thrombolytic therapy with those who did not.

POPULATION AND METHODS

A retrospective study was done on 907 patients (median age: 35 +/- 13 years, 66% male) admitted to a Coronary Unit with the diagnosis of first Q AMI, from January 1988 to December 1997, all in the same geographical area (minimum follow-up period of one year, mean follow-up 43 +/- 37 months). We compared demographics and clinical characteristics (coronary risk factors, previous history of angina, MI location and evolution, cardiac events, 28 day and one-year mortality) of patients who underwent thrombolysis (group T = 355) versus those who did not undergo reperfusion therapy (group NT = 552).

RESULTS

Of these patients 39% underwent thrombolytic therapy. Group NT had a greater number of female patients (40% vs 25%; p < 0.001), a significantly higher mean age (67 +/- 12.2 vs 61 +/- 12; p < 0.001), and a higher percentage of diabetics (29% vs 19%; p < 0.001), in comparison to group T. The Q AMI developed into Killip class > or = 2 in 43% of patients in group NT and 23% in group T (p < 0.001). A higher number of AV block (NT-13% vs T-8%; p < 0.05) and higher in-hospital mortality (NT-14% vs T-9%; p < 0.05) was observed in patients not undergoing thrombolysis. The early (NT-22% vs T-12%; p < 0.001) and one-year (NT-33% vs T-16%; p < 0.001) mortalities were significantly higher in group NT than in group T, even after multivariate analysis.

CONCLUSIONS

1--Patients who did not undergo thrombolytic therapy initially had a profile of greater severity, and a higher early and one-year mortality rate. 2--Those who underwent thrombolytic therapy presented a significantly lower mortality, a benefit that was still observed after one year of follow-up and after multivariate correction.

摘要

引言与目的

溶栓治疗仍被广泛用于恢复梗死相关动脉（IRA）的前向血流，在降低此类患者死亡率方面具有毋庸置疑的益处。本研究旨在评估首次发生Q波心肌梗死（Q AMI）患者的早期（≤28天）和一年死亡率，比较接受溶栓治疗的患者与未接受溶栓治疗的患者。

研究对象与方法

对1988年1月至1997年12月期间收治于冠心病监护病房、诊断为首次Q AMI的907例患者（中位年龄：35±13岁，66%为男性）进行了一项回顾性研究，所有患者均来自同一地理区域（最短随访期为一年，平均随访43±37个月）。我们比较了接受溶栓治疗的患者（T组 = 355例）与未接受再灌注治疗的患者（非T组 = 552例）的人口统计学和临床特征（冠心病危险因素、既往心绞痛病史、心肌梗死部位及演变、心脏事件、28天和一年死亡率）。

结果

这些患者中39%接受了溶栓治疗。与T组相比，非T组女性患者数量更多（40%对25%；p < 0.001），平均年龄显著更高（67±12.2岁对61±12岁；p < 0.001），糖尿病患者比例更高（29%对19%；p < 0.001）。非T组43%的患者Q AMI发展为Killip分级≥2级，T组为23%（p < 0.001）。未接受溶栓治疗的患者中观察到更高的房室传导阻滞发生率（非T组 - 13%对T组 - 8%；p < 0.05）和更高的院内死亡率（非T组 - 14%对T组 - 9%；p < 0.05）。即使经过多因素分析，非T组的早期死亡率（非T组 - 22%对T组 - 12%；p < 0.001）和一年死亡率（非T组 - 33%对T组 - 16%；p < 0.001）仍显著高于T组。