Spencer F A, Goldberg R J, Frederick P D, Malmgren J, Becker R C, Gore J M
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Am J Cardiol. 2001 Jul 15;88(2):107-11. doi: 10.1016/s0002-9149(01)01602-2.
Considerable data indicates that patients <50 years of age have lower morbidity and mortality after acute myocardial infarction (AMI) than older patients. It has been demonstrated that use of routine cardiac catheterization and revascularization in younger patients with AMI and successful thrombolysis does not confer benefit compared with a more conservative approach. Despite this, it has been our impression that cardiac catheterization is frequently employed in younger patients with AMI. Patients with uncomplicated initial AMI treated with thrombolytic therapy in the Second National Registry of Myocardial Infarction (NRMI-2) between June 1994 and April 1998 were identified. Patients were categorized into 4 age strata for purposes of analysis. A total of 61,232 cases met our inclusion criteria. Cardiac catheterization was performed during hospitalization in 78% of patients after an uncomplicated initial AMI. Age was inversely associated with receipt of cardiac catheterization: 85% of those < or =49 years old underwent catheterization compared with 63% of those > or =70 years old. Regression analysis revealed that use of catheterization was 2.9 times greater (95% confidence intervals 2.7 to 3.2) in patients < or =49 years old compared with those > or =70 years old. Geographic location and payor status also strongly influenced utilization of this procedure. In conclusion, routine coronary angiography after uncomplicated AMI is extensively utilized in all age groups, particularly in those <50 years of age. The efficacy and cost effectiveness of this strategy in these patients has not yet been determined in clinical trials.
大量数据表明，年龄小于50岁的急性心肌梗死（AMI）患者比老年患者的发病率和死亡率更低。已有研究表明，对于急性心肌梗死且溶栓成功的年轻患者，采用常规心脏导管插入术和血运重建术与采用更保守的方法相比并无益处。尽管如此，我们的印象是心脏导管插入术在年轻的急性心肌梗死患者中仍经常被使用。我们确定了1994年6月至1998年4月在第二次全国心肌梗死登记处（NRMI-2）接受溶栓治疗的初发无并发症急性心肌梗死患者。为了分析，将患者分为4个年龄层。共有61232例符合我们的纳入标准。在初发无并发症急性心肌梗死后，78%的患者在住院期间接受了心脏导管插入术。年龄与接受心脏导管插入术呈负相关：年龄小于或等于49岁的患者中有85%接受了导管插入术，而年龄大于或等于70岁的患者中这一比例为63%。回归分析显示，年龄小于或等于49岁的患者接受导管插入术的几率是年龄大于或等于70岁患者的2.9倍（95%置信区间为2.7至3.2）。地理位置和付款人身份也强烈影响了该手术的使用情况。总之，初发无并发症急性心肌梗死后的常规冠状动脉造影在所有年龄组中都被广泛使用，尤其是在年龄小于50岁的人群中。该策略在这些患者中的疗效和成本效益尚未在临床试验中确定。
