Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong.
Singapore Med J. 2009 Oct;50(10):956-61.
Compared with anterior wall myocardial infarction, inferior wall myocardial infarction is generally regarded as being low risk. The aim of this study was to elucidate the clinical factors affecting its inhospital outcome.
From January 1997 to March 2006, 546 consecutive patients who suffered from their first inferior wall myocardial infarction were recruited for the study. The demographic, clinical, electrocardiographical and angiographical characteristics, treatment and medications, complications and inhospital deaths were subjected to univariate analysis. The factors that had a p-value of less than 0.1 were included for multivariate logistic regression analysis. A p-value of less than 0.05 was considered significant. The impact of thrombolysis on clinical outcome in various high-risk patient subsets was also examined.
An advanced age of more than 74 years, female gender, lateral wall extension, complete atrioventricular block, bundle branch block, and cardiac free-wall rupture were found to be independent predictors of inhospital mortality, whereas the use of thrombolysis was associated with a favourable outcome. On the other hand, right ventricular infarction and precordial ST-segment depression are not predictive of poor outcome. In addition, thrombolysis reduced inhospital mortality in patients with an age above 64 years, male gender, lateral wall extension, haemodynamically-significant right ventricular infarction and complete atrioventricular block.
In inferior wall myocardial infarction, independent predictors of poor inhospital outcome are advanced age, female gender, lateral wall extension, complete atrioventricular block, bundle branch block and cardiac free-wall rupture. The use of thrombolysis is generally beneficial, especially in those of the high-risk subsets.
与前壁心肌梗死相比，下壁心肌梗死通常被认为风险较低。本研究旨在阐明影响其住院期间预后的临床因素。
从 1997 年 1 月至 2006 年 3 月，连续招募了 546 例首次发生下壁心肌梗死的患者进行研究。对患者的人口统计学、临床、心电图和血管造影特征、治疗和药物使用、并发症和住院期间死亡进行单因素分析。将 p 值小于 0.1 的因素纳入多因素逻辑回归分析。p 值小于 0.05 被认为具有统计学意义。还检查了溶栓治疗对各种高危患者亚组临床结局的影响。
年龄大于 74 岁、女性、侧壁扩展、完全性房室传导阻滞、束支传导阻滞和心脏游离壁破裂被发现是住院期间死亡率的独立预测因素，而溶栓治疗与良好的结局相关。另一方面，右心室梗死和胸前 ST 段压低不能预测不良预后。此外，溶栓治疗降低了年龄大于 64 岁、男性、侧壁扩展、有血流动力学意义的右心室梗死和完全性房室传导阻滞患者的住院期间死亡率。
在下壁心肌梗死中，不良住院预后的独立预测因素是年龄较大、女性、侧壁扩展、完全性房室传导阻滞、束支传导阻滞和心脏游离壁破裂。溶栓治疗通常是有益的，尤其是在高危亚组中。
