[复发性心肌梗死患者的临床病程及长期预后]

[Clinical course and long-term prognosis in patients with recurrent myocardial infarction].

作者信息

Janion M, Kurzawski J

机构信息

Oddział Kardiologii Wojewódzkiego Szpitala Zespolonego w Kielcach.

出版信息

Pol Arch Med Wewn. 2000 Jan-Feb;103(1-2):53-9.

PMID:11236259

Abstract

UNLABELLED

Retrospective study was based on analysis of 881 patients treated in our ward in 1992-1996. Their fate was estimated through 2-6 years after the past myocardial infarction (MI). There were among of them 147 (16.7%) with second and 20 (2.3%) with third or next MI. Then we compared in-hospital course and long-term prognosis in patients with recurrent MI (group I, n = 167) to patients with the first MI (group II, n = 714). We have also evaluated influence of the time-period between the both episodes of myocardial infarctions on the prognosis. The chi-square test was applied to identify the significance of the difference between both groups. Using the Kaplan-Meier method, figures of survival curves were created. Patients in group I were about 4.9 year-older than in group II/(median age was 64.8 +/- 10.7 vs 59.9 +/- +/- 11.3 years p < 0.05). More popular were also diabetes (30.5% vs 18.5%, p < 0.001), advanced hypertension (31.7% vs 20.5% p < 0.01) and higher ratio of current smokers (51.5%) among risk factors in patients from group I. Second myocardial infarction had more serious in-hospital course than the first one. It could be the result of anterior location and more often cardiac complications like ventricular arrhythmias including VF, disturbances of intraventricular conductions, cardiogenic shock and pulmonary oedema with especially of first hours of acute myocardial infarction. Mortality rate in the group I was 2.2 times higher to compare with group II (24.0% vs 10.9%, p < 0.001). Significance higher mortality was in the first year of follow-up and among patients with recurrent myocardial infarction within 12 months after the first one.

CONCLUSION

Previous myocardial infarction is significant risk factor that elevate in-hospital course and long-term mortality rate. We observed the higher mortality rate when the recurrent myocardial infarction occurred within 12 months after the first one. The longer time-period since the first myocardial infarction the better prognosis was observed in our analysis.

摘要

未标注

回顾性研究基于对1992 - 1996年在我们病房接受治疗的881例患者的分析。在过去心肌梗死（MI）后2至6年评估他们的预后情况。其中有147例（16.7%）发生第二次心肌梗死，20例（2.3%）发生第三次或再次心肌梗死。然后我们将复发性心肌梗死患者（第一组，n = 167）与首次心肌梗死患者（第二组，n = 714）的住院过程和长期预后进行了比较。我们还评估了两次心肌梗死发作之间的时间间隔对预后的影响。应用卡方检验来确定两组之间差异的显著性。使用Kaplan - Meier方法绘制生存曲线。第一组患者比第二组患者大4.9岁左右/（中位年龄分别为64.8±10.7岁和59.9±11.3岁，p < 0.05）。在第一组患者的危险因素中，糖尿病（30.5%对18.5%，p < 0.001）、重度高血压（31.7%对20.5%，p < 0.01）以及当前吸烟者的比例更高（51.5%）也更为常见。第二次心肌梗死的住院过程比第一次更严重。这可能是由于梗死部位在前壁，并且在急性心肌梗死的最初几个小时内更常出现心脏并发症，如包括室颤在内的室性心律失常、室内传导障碍、心源性休克和肺水肿。第一组的死亡率比第二组高2.2倍（24.0%对10.9%，p < 0.001）。在随访的第一年以及首次心肌梗死后12个月内发生复发性心肌梗死的患者中，死亡率显著更高。