Jugdutt B I, Basualdo C A
Department of Medicine, University of Alberta, Edmonton.
Can J Cardiol. 1989 May;5(4):211-21.
Evidence of acute infarct expansion and the frequency of the acute infarct expansion syndrome (acute infarct dilatation and thinning associated with hypotension and left ventricular failure but no evidence of new necrosis) occurring at two days or more after a first acute Q-wave myocardial infarction were studied using serial two-dimensional echocardiography in 221 consecutive patients (100 anterior, 121 inferior). Patients with symptomatic pericarditis were treated with indomethacin (group 1, n = 73) or ibuprofen (group 2, n = 49) and those without symptomatic pericarditis received neither drug (group 3, n = 99). The overall frequency of the acute infarct expansion syndrome was 13% and 69% of these were among the pericarditis groups. The syndrome was significantly more frequent in group 1 (22%) than group 2 (8%) (P less than 0.05) or group 3 (9%) (P less than 0.025). Serial echocardiograms revealed more expansion with greater percentage increase in the infarct containing segment length in group 1 than group 2 or group 3 (18% versus 9% versus 9%, P less than 0.005). However, the decreases in infarct segment thickness were similar in groups 1 (24%) and 2 (25%) but greater (P less than 0.001) than in group 3 (7%). Despite similar infarct size and infarct thinning in groups 1 and 2, the degree of infarct expansion was greater and the infarct expansion syndrome more frequent in group 1. However, when allowance was made for the potential protective effect of prior use of intravenous nitroglycerin and concomitant use of nifedipine, indomethacin and ibuprofen had similar effects on expansion. Thus, indomethacin or ibuprofen should be used with caution after Q-wave infarction so as to avoid further expansion. The fact that short term use of other drugs might modify infarct remodelling should be considered in studies attempting to assess efficacy of one particular drug.(ABSTRACT TRUNCATED AT 400 WORDS)
采用连续二维超声心动图对221例连续的首次急性Q波心肌梗死患者（100例前壁梗死，121例下壁梗死）进行研究，以观察首次急性Q波心肌梗死后两天或更长时间发生急性梗死扩展及急性梗死扩展综合征（急性梗死扩张并变薄，伴有低血压和左心室衰竭，但无新坏死证据）的情况。有症状性心包炎的患者接受吲哚美辛治疗（第1组，n = 73）或布洛芬治疗（第2组，n = 49），无症状性心包炎的患者未接受任何药物治疗（第3组，n = 99）。急性梗死扩展综合征的总体发生率为13%，其中69%发生于心包炎组。该综合征在第1组（22%）的发生率显著高于第2组（8%）（P < 0.05）或第3组（9%）（P < 0.025）。连续超声心动图显示，第1组梗死节段长度的增加百分比和扩展程度大于第2组或第3组（分别为18%、9%、9%，P < 0.005）。然而，第1组（24%）和第2组（25%）梗死节段厚度的降低相似，但大于第3组（7%）（P < 0.001）。尽管第1组和第2组梗死面积和梗死变薄情况相似，但第1组梗死扩展程度更大，急性梗死扩展综合征更常见。然而，考虑到先前使用静脉硝酸甘油的潜在保护作用以及同时使用硝苯地平的情况，吲哚美辛和布洛芬对梗死扩展的影响相似。因此，Q波梗死之后使用吲哚美辛或布洛芬应谨慎，以免进一步扩展。在试图评估某一特定药物疗效的研究中，应考虑短期使用其他药物可能改变梗死重构这一事实。（摘要截选至400字）
