高血压患者急性 ST 段抬高型心肌梗死的临床病程。

The clinical course of acute ST-elevation myocardial infarction in patients with hypertension.

机构信息

Department of Cardiology, Medical University, Lodz, Poland.

出版信息

Kardiol Pol. 2010 Feb;68(2):157-63.

PMID:20301024

Abstract

BACKGROUND

Arterial hypertension has been documented as one the cardiovascular risk factors. The issue whether hypertension worsens the clinical course and short-term prognosis of patients with acute ST-elevation myocardial infarction (STEMI) has been addressed by several studies, however, the results were not uniform.

AIM

To compare the clinical course and short-term prognosis in STEMI patients with or without hypertension.

METHODS

The study group consisted of 366 patients with STEMI, of whom 234 (63.9%) had a history of hypertension (150 males, mean age 58.5+/-11.2 years) whereas 132 (100 males, mean age 60.3+/-11.9) did not. All patients underwent primary angioplasty with stent implantation. Details from medical history, cardiovascular risk factors, clinical course and in-hospital complications were recorded and compared between patients with and without hypertension.

RESULTS

There were differences between both study groups in the prevalence of cardiovascular risk factors. Patients with hypertension had more frequently history of coronary artery disease (56 vs. 37%, p<0.01), BMI>25 kg/m2 (90 vs. 85%, p<0.01), type 2 diabetes (27 vs. 14%, p<0.05), hyperlipidaemia (56 vs. 43%, p<0.05), and renal disease (11 vs. 5%, p<0.05). Clinical course of MI was more complicated in patients with hypertension who had more often cardiogenic shock (10 vs. 6%, p<0.05), pulmonary oedema (12 vs. 4%, p<0.05), sinus tachycardia>90 beats/min on admission (12 vs. 4%, p<0.05), ventricular tachycardia or fibrillation (20 vs. 11%, p<0.01) and complete atrioventricular block (11 vs. 4%, p<0.01). In-hospital deaths occurred in 18 (7.7%) patients with hypertension and 7 (5.3%) patients without hypertension (NS). Multivariate analysis identified age>65 years, symptoms of heart failure, atrial fibrillation, elevated blood glucose level and creatinine level as independent prognostic factors of adverse outcome in both groups whereas history of stroke, increased while cell blood count, urea level and two-vessel disease where independent prognostic variables in patients with hypertension. Ventricular tachycardia or fibrillation had prognostic significance only in STEMI patients without hypertension.

CONCLUSION

Patients with STEMI and hypertension have more cardiovascular risk factors and more complicated in-hospital course of MI than normotensive patients.

摘要

背景

动脉高血压已被证实是心血管风险因素之一。几项研究已经探讨了高血压是否会加重急性 ST 段抬高型心肌梗死（STEMI）患者的临床病程和短期预后，但结果并不一致。

目的

比较 STEMI 患者合并或不合并高血压的临床病程和短期预后。

方法

研究组包括 366 例 STEMI 患者，其中 234 例（63.9%）有高血压病史（男 150 例，平均年龄 58.5+/-11.2 岁），132 例（男 100 例，平均年龄 60.3+/-11.9 岁）无高血压病史。所有患者均接受了经皮冠状动脉介入治疗（PCI）支架植入术。记录并比较了两组患者的病史、心血管危险因素、临床病程和院内并发症等详细信息。

结果

两组患者的心血管危险因素存在差异。高血压组患者更常患有冠心病（56%比 37%，p<0.01）、BMI>25kg/m2（90%比 85%，p<0.01）、2 型糖尿病（27%比 14%，p<0.05）、高脂血症（56%比 43%，p<0.05）和肾脏疾病（11%比 5%，p<0.05）。高血压组患者的心肌梗死临床病程更为复杂，更常出现心源性休克（10%比 6%，p<0.05）、肺水肿（12%比 4%，p<0.05）、入院时窦性心动过速>90 次/分（12%比 4%，p<0.05）、室性心动过速或颤动（20%比 11%，p<0.01）和完全性房室传导阻滞（11%比 4%，p<0.01）。高血压组有 18 例（7.7%）患者院内死亡，无高血压组有 7 例（5.3%）患者院内死亡（NS）。多因素分析显示，年龄>65 岁、心力衰竭症状、心房颤动、血糖和肌酐水平升高是两组患者不良预后的独立预测因素，而脑卒中史、白细胞计数升高、尿素水平和双血管病变是高血压患者的独立预测变量。室性心动过速或颤动仅对无高血压的 STEMI 患者具有预后意义。