Lotto A, Colombo A, Talarico G, Fratianni G, Lettino M
Cardiology Department, Ospedale Maggiore Policlinico, Milan, Italy.
Haemostasis. 1990;20 Suppl 1:132-41. doi: 10.1159/000216171.
Patients surviving acute myocardial infarction (AMI) may experience several clinical events (reinfarction, congestive heart failure, sudden death) still responsible for high mortality rates. AMI early complicated by residual angina, left ventricular dysfunction, or malignant arrhythmias has a worse prognosis. Secondary prevention of myocardial infarction and death has been the end point of many clinical trials in the past two decades. It is well known that beta blockers prevent sudden death if administered chronically after AMI. Meta-analysis of controlled randomized trials demonstrated a significant reduction in reinfarction and vascular death with long-term antiplatelet treatment. Oral anticoagulants prevent fatal and non-fatal reinfarction and show a trend towards lower mortality rates, though treated patients have a higher incidence of haemorrhagic events, particularly stroke. Early administration of heparin gave contradictory results on short-term prevention of myocardial infarction and death after AMI. Data on long-term heparin therapy point out a significant reduction in recurrent AMI and a trend towards a decrease in general mortality.
急性心肌梗死（AMI）幸存者可能会经历多种临床事件（再梗死、充血性心力衰竭、猝死），这些事件仍是导致高死亡率的原因。早期并发残余心绞痛、左心室功能障碍或恶性心律失常的AMI患者预后较差。在过去二十年中，心肌梗死和死亡的二级预防一直是许多临床试验的终点。众所周知，β受体阻滞剂在AMI后长期服用可预防猝死。对对照随机试验的荟萃分析表明，长期抗血小板治疗可显著降低再梗死和血管性死亡的发生率。口服抗凝剂可预防致命性和非致命性再梗死，并显示出死亡率降低的趋势，尽管接受治疗的患者出血事件发生率较高，尤其是中风。早期给予肝素在AMI后短期预防心肌梗死和死亡方面得出了相互矛盾的结果。长期肝素治疗的数据表明，复发性AMI显著减少，总体死亡率有下降趋势。
