Nadelmann J, Frishman W H, Ooi W L, Tepper D, Greenberg S, Guzik H, Lazar E J, Heiman M, Aronson M
Department of Medicine, Albert Einstein Hospital, Bronx, New York 10461.
Am J Cardiol. 1990 Sep 1;66(5):533-7. doi: 10.1016/0002-9149(90)90477-i.
The prevalence, incidence and prognosis of recognized and unrecognized Q-wave myocardial infarction (MI) was assessed in an 8-year prospective study of 390 community-based subjects (age 75 to 85 years at entry, mean 79 years). Subjects were studied at baseline and with annual follow-up electrocardiographic (ECG) exams. At baseline, 7.9% had a history of MI without ECG evidence, 6.4% had ECG evidence of Q-wave MI without clinical history, 4.1% had both clinical history and ECG evidence and 81.5% had neither history nor ECG evidence (control subjects). After an average follow-up period of 76.2 months, the total mortality rate was 5.9/100 person-years for subjects with some evidence of MI at baseline versus 3.9 in the control group (p = 0.059). The incidence of cardiovascular disease in subjects with evidence of MI was 8.8/100 person-years versus 4.7 among control subjects (p = 0.002). During the follow-up period, 115 new Q-wave MIs occurred (50 unrecognized, rate 2.4/100; 65 recognized, rate 3.2/100). There was no difference in mortality and morbidity outcome between subjects with recognized and unrecognized MIs. Those with only a history of MI at baseline had a threefold greater risk of a new MI (recognized and unrecognized) than the control group (p = 0.003). Unrecognized Q-wave MI is a common occurrence in the "old old" with subsequent morbidity and mortality prognosis comparable to that of recognized MI. History of MI alone in this age group is also associated with an increased risk of MI, suggesting the need for better diagnostic markers of myocardial ischemia in the old.
在一项针对390名社区居民（入组时年龄为75至85岁，平均79岁）的8年前瞻性研究中，评估了已确诊和未确诊的Q波心肌梗死（MI）的患病率、发病率和预后。在基线时以及每年进行的随访心电图（ECG）检查中对受试者进行研究。基线时，7.9%的人有心肌梗死病史但无心电图证据，6.4%的人有Q波心肌梗死的心电图证据但无临床病史，4.1%的人既有临床病史又有心电图证据，81.5%的人既无病史也无心电图证据（对照组）。经过平均76.2个月的随访期，基线时有心肌梗死证据的受试者的总死亡率为5.9/100人年，而对照组为3.9/100人年（p = 0.059）。有心肌梗死证据的受试者心血管疾病的发病率为8.8/100人年，而对照组为4.7/100人年（p = 0.002）。在随访期间，发生了115例新的Q波心肌梗死（50例未被识别，发生率为2.4/100；65例被识别，发生率为3.2/100）。已确诊和未确诊心肌梗死的受试者在死亡率和发病率结果方面没有差异。基线时仅有心肌梗死病史的人发生新的心肌梗死（已确诊和未确诊）的风险比对照组高两倍（p = 0.003）。未被识别的Q波心肌梗死在“高龄老人”中很常见，其随后的发病率和死亡率预后与已确诊的心肌梗死相当。在这个年龄组中，仅心肌梗死病史也与心肌梗死风险增加相关，这表明需要更好的心肌缺血诊断标志物用于老年人。
