Torabi Azam, Cleland John G F, Khan Nasrin K, Loh Puan H, Clark Andrew L, Alamgir Farqad, Caplin John L, Rigby Alan S, Goode Kevin
Department of Cardiology, Hull Royal Infirmary, University of Hull Castle Hill Hospital, Kingston-upon-Hull, Castle Road, Cottingham, East Yorkshire HU16 5JQ, UK.
Eur Heart J. 2008 Apr;29(7):859-70. doi: 10.1093/eurheartj/ehn096. Epub 2008 Mar 19.
Myocardial infarction (MI) is a common cause of heart failure (HF), which may develop early and persist or resolve, or develop late. The cumulative incidence, persistence, and resolution of HF after MI are poorly described. The aim of this study is to describe the natural history and prognosis of HF after an MI.
Patients with a death or discharge diagnosis of MI in 1998 were identified from records of hospitals providing services to a local community of 600 000 people. Records were scrutinized to identify the development of HF, defined as signs and symptoms consistent with that diagnosis and treated with loop diuretics. HF was considered to have resolved if diuretics could be stopped without recurrent symptoms. Totally, 896 patients were identified of whom 54% had died by December 2005. During the index admission, 199 (22.2%) patients died, many with HF, and a further 182 (20.3%) patients developed HF that persisted until discharge, of whom 121 died subsequent to discharge. Of 74 patients with transient HF that resolved before discharge, 41 had recurrent HF and 38 died during follow-up. After discharge, 145 (33%) patients developed HF for the first time, of whom 76 died during follow-up. Overall, of 281 deaths occurring after discharge, 235 (83.6%) were amongst inpatients who first developed HF.
The development of HF precedes death in most patients who die in the short- or long-term following an MI. Prevention of HF, predominantly by reducing the extent of myocardial damage and recurrent MI, and subsequent management could have a substantial impact on prognosis.
心肌梗死（MI）是心力衰竭（HF）的常见病因，HF可能早期发生并持续存在或缓解，也可能晚期发生。心肌梗死后HF的累积发病率、持续存在情况及缓解情况鲜有描述。本研究旨在描述心肌梗死后HF的自然病史和预后。
从为当地60万人口社区提供服务的医院记录中，识别出1998年有死亡或出院诊断为心肌梗死的患者。仔细审查记录以确定HF的发生情况，HF定义为符合该诊断的体征和症状并接受襻利尿剂治疗。如果停用利尿剂后无复发症状，则认为HF已缓解。总共识别出896例患者，到2005年12月时其中54%已死亡。在首次住院期间，199例（22.2%）患者死亡，许多伴有HF，另有182例（20.3%）患者发生HF并持续至出院，其中121例出院后死亡。74例在出院前缓解的短暂性HF患者中，41例复发HF，38例在随访期间死亡。出院后，145例（33%）患者首次发生HF，其中76例在随访期间死亡。总体而言，出院后发生的281例死亡中，235例（83.6%）是首次发生HF的住院患者。
在心肌梗死后短期或长期死亡的大多数患者中，HF的发生先于死亡。主要通过减少心肌损伤程度和复发性心肌梗死来预防HF，以及后续的管理可能对预后产生重大影响。
