Young John J, Chung Eugene S, Menon Santosh G, Chow Theodore, Mital Anubhav, Pastore Joseph, Kereiakes Dean J
The Ohio Heart & Vascular Center, The Lindner Center for Research & Education at The Christ Hospital, Cincinnati, Ohio, USA.
J Invasive Cardiol. 2006 Nov;18(11):540-3.
Myocardial infarction (MI) complicated by severe left ventricular (LV) dysfunction is associated with significant morbidity and mortality. The natural history of this population with contemporary revascularization and guideline-based medical therapies is poorly defined. We sought to determine the impact of contemporary treatment strategies on LV function and prognosis in patients with MI and severe LV dysfunction.
Consecutive MI patients were prospectively followed as part of an ongoing internal database. The current report comprises 75 patients with first MI and severe LV systolic dysfunction (EF less than or equal to 3%). Initial demographic and clinical data were collected during hospitalization and at 1-, 3- and 6-month follow up.
Patients were 71% male, 36% diabetic and 51% had prior coronary disease with a mean (+/- SD) age of 65 +/- 14 years. The average hospital stay was 5.7 days for ST-elevation (CPK range 424 to 5,250) and 2.4 days for non-ST-elevation MI (CPK range 175 to 705). Revascularization in-hospital was performed in 87% of patients (62 percutaneous, 3 surgical). At hospital discharge, treatment included beta-blockers (84%), ACE-inhibitors (73%), statins (81%), aspirin (88%) and clopidogrel (84%). Mean (+/- SD) LVEF was 25.7 +/- 5.9% in hospital, 36.6 +/- 11.8% by 1 to 3 months (p < 0.01), and 37.6 +/- 9.3% at 6 months (p < 0.01). By 1 to 3 months, 63% had improved LVEF, 24% were unchanged and 14% were worse. One patient died in the hospital and 3 died by 6-month follow up (mortality 5.3%).
A strategy of early revascularization combined with guideline-based medical management favorably impacts LV function and short-term prognosis in MI patients with severe LV systolic dysfunction. With contemporary treatment strategies, the majority (> 60%) of patients demonstrate improvement in LVEF and mortality is low (5.3%).
心肌梗死（MI）合并严重左心室（LV）功能障碍与显著的发病率和死亡率相关。当代血管重建和基于指南的药物治疗下该人群的自然病史尚不明确。我们试图确定当代治疗策略对MI合并严重LV功能障碍患者的LV功能和预后的影响。
作为正在进行的内部数据库的一部分，对连续的MI患者进行前瞻性随访。本报告纳入了75例首次发生MI且伴有严重LV收缩功能障碍（左心室射血分数[EF]小于或等于3%）的患者。在住院期间以及1个月、3个月和6个月随访时收集初始人口统计学和临床数据。
患者中男性占71%，糖尿病患者占36%，51%有冠心病病史，平均（±标准差）年龄为65±14岁。ST段抬高型心肌梗死患者（肌酸磷酸激酶[CPK]范围为424至5250）的平均住院天数为5.7天，非ST段抬高型心肌梗死患者（CPK范围为175至705）的平均住院天数为2.4天。87%的患者在住院期间接受了血管重建治疗（62例经皮介入，3例外科手术）。出院时，治疗包括使用β受体阻滞剂（84%）、血管紧张素转换酶抑制剂（ACEI，73%）、他汀类药物（81%）、阿司匹林（88%）和氯吡格雷（84%）。住院时平均（±标准差）LVEF为25.7±5.9%，1至3个月时为36.6±11.8%（p<0.01），6个月时为37.6±9.3%（p<0.01）。到1至3个月时，63%的患者LVEF有所改善，24%的患者LVEF不变，14%的患者LVEF恶化。1例患者在住院期间死亡，3例患者在6个月随访时死亡（死亡率5.3%）。
早期血管重建联合基于指南的药物治疗策略对MI合并严重LV收缩功能障碍患者的LV功能和短期预后有积极影响。采用当代治疗策略时，大多数（>60%）患者的LVEF有所改善，死亡率较低（5.3%）。
