Sakakura Kenichi, Kubo Norifumi, Ako Junya, Ikeda Nahoko, Funayama Hiroshi, Hirahara Taishi, Wada Hiroshi, Sugawara Yoshitaka, Yasu Takanori, Kawakami Masanobu, Momomura Shin-ichi
Division of Cardiovascular Medicine, Department of Integrated Medicine I, Jichi Medical University Saitama Medical Center, Omiya, Saitama, Japan.
Heart Vessels. 2009 Sep;24(5):347-51. doi: 10.1007/s00380-008-1133-y. Epub 2009 Sep 27.
Recurrence of myocardial infarction, especially when occurring early after the prior one, carries a significant morbidity and mortality rate. The aim of this study was to investigate the characteristics of patients who experienced recurrence under secondary prevention therapy. Case record review identified myocardial infarction patients who had a history of previous myocardial infarction within 5 years. Hospital chart records, initial laboratory data, medications, and type of infarction were reviewed. Patients were divided into two groups according to the interval of recurrence: an early group (recurrence within 1 year), and a late group (recurrence after more than 1 year). A total of 89 patients were included in the analysis; 40 patients in the early group, and 49 patients in the late group. Mean age in the early group and late groups was 67.3 +/- 11.9 and 59.4 +/- 8.9, respectively (P = 0.001). Mean body mass index in the early and late groups was 22.1 +/- 3.6 and 25.0 +/- 3.3, respectively (P < 0.001). There were fewer current smokers in the early group (7.5% vs 44.9%, P < 0.001) and more stent thrombosis (17.5% vs 2%, P = 0.02), as compared with the late group. The in-hospital mortality rate tended to be higher in the early group (7.5% vs 0%, P = 0.09). Multiple logistic regression revealed that smoking status (odds ratio [OR] 0.09, 95% confidence interval [CI] 0.02-0.49, P = 0.005), HDL cholesterol level (5 mg/dl increase: OR 1.34, 95% CI 1.04-1.74, P = 0.03), and stent thrombosis (OR 35.59, 95% CI 2.13-595.49, P = 0.01) had significant associations with early recurrence. Early recurrence of myocardial infarction was associated with stent thrombosis, a higher HDL cholesterol level, and a lower frequency of smoking. Early recurrence had a trend toward higher mortality than late recurrence.
心肌梗死复发，尤其是在前次心肌梗死后不久发生时，具有显著的发病率和死亡率。本研究的目的是调查在二级预防治疗下经历复发的患者的特征。病例记录回顾确定了在5年内有过心肌梗死病史的心肌梗死患者。回顾了医院病历记录、初始实验室数据、用药情况和梗死类型。根据复发间隔将患者分为两组：早期组（1年内复发）和晚期组（1年后复发）。共有89例患者纳入分析；早期组40例，晚期组49例。早期组和晚期组的平均年龄分别为67.3±11.9岁和59.4±8.9岁（P = 0.001）。早期组和晚期组的平均体重指数分别为22.1±3.6和25.0±3.3（P < 0.001）。与晚期组相比，早期组当前吸烟者较少（7.5%对44.9%，P < 0.001），支架血栓形成较多（17.5%对2%，P = 0.02）。早期组的院内死亡率有更高的趋势（7.5%对0%，P = 0.09）。多因素逻辑回归显示，吸烟状况（比值比[OR]0.09，95%置信区间[CI]0.02 - 0.49，P = 0.005）、高密度脂蛋白胆固醇水平（每增加5mg/dl：OR 1.34，95%CI 1.04 - 1.74，P = 0.03）和支架血栓形成（OR 35.59，95%CI 2.13 - 595.49，P = 0.01）与早期复发有显著关联。心肌梗死早期复发与支架血栓形成、较高的高密度脂蛋白胆固醇水平和较低的吸烟频率有关。早期复发的死亡率有高于晚期复发的趋势。
