de Cock C C, Visser F C, van Eenige M J, Roos J P
Department of Cardiology, Free University Hospital, Amsterdam, The Netherlands.
Int J Cardiol. 1989 Aug;24(2):197-209. doi: 10.1016/0167-5273(89)90305-7.
To assess prospectively short-term (1 year) and long-term (4 years) prognostic variables from heart catheterization, 325 consecutive patients of 65 years or less who survived a myocardial infarction were studied. In all coronary angiography and left ventriculography was performed 4-6 weeks after infarction. First year mortality rate was significantly higher in patients with an ejection fraction less than 0.30 (20%) than in patients with an ejection fraction greater than or equal to 0.30 (2%, P less than 0.001). During 4-year follow-up cumulative mortality was 44% in patients with an ejection fraction less than 0.30 vs 11% in patients with an ejection fraction greater than or equal to 0.30 (P less than 0.001). In patients who survived the first year after infarction, however, a low ejection fraction less than 0.30 was not associated with higher mortality rate during the subsequent 3 years. Mortality in patients with one-, two- or three-vessel disease was equally distributed in the first year. After 4 years patients with three-vessel disease had a significant higher mortality (32%) than patients with two- or one-vessel disease (12 and 11%, respectively; P less than 0.05). Reinfarction rate was higher in patients with an ejection fraction less than 0.30 (14%) than in patients with an ejection fraction greater than or equal to 0.30 (3%, P less than 0.05) in the first year. During 4-year follow-up reinfarction rate was 38% in patients with an ejection fraction less than 0.30 vs. 13% in patients with an ejection fraction greater than or equal to 0.30 (P less than 0.05). Again, in patients who survived the first year without reinfarction, an ejection fraction less than 0.30 had no prognostic value for recurrent myocardial infarction during the subsequent three years. Three-vessel disease had no higher reinfarction rate in the first year of follow-up: during 4 years, patients with three-vessel disease had a reinfarction rate (32%) compared to patients with two- and one-vessel disease (14 and 11%, respectively; P less than 0.05). It is concluded that an ejection fraction less than 0.30 is a major risk factor for cardiac death and reinfarction only in the first year after myocardial infarction. Beyond the first year, a subgroup of patients with three-vessel disease is at risk for both cardiac death and reinfarction during the three subsequent years.
为前瞻性评估心脏导管检查的短期（1年）和长期（4年）预后变量，我们研究了325例65岁及以下心肌梗死后存活的连续患者。所有患者均在心肌梗死后4 - 6周进行了冠状动脉造影和左心室造影。射血分数小于0.30的患者第一年死亡率（20%）显著高于射血分数大于或等于0.30的患者（2%，P<0.001）。在4年随访期间，射血分数小于0.30的患者累积死亡率为44%，而射血分数大于或等于0.30的患者为11%（P<0.001）。然而，在心肌梗死后存活一年的患者中，射血分数小于0.30与随后3年的较高死亡率无关。单支、双支或三支血管病变患者的第一年死亡率分布相同。4年后，三支血管病变患者的死亡率（32%）显著高于双支或单支血管病变患者（分别为12%和11%；P<0.05）。第一年，射血分数小于0.30的患者再梗死率（14%）高于射血分数大于或等于0.30的患者（3%，P<0.05）。在4年随访期间，射血分数小于0.30的患者再梗死率为38%，而射血分数大于或等于0.30的患者为13%（P<0.05）。同样，在第一年无再梗死存活的患者中，射血分数小于0.30对随后三年复发性心肌梗死无预后价值。随访第一年，三支血管病变患者的再梗死率并不更高：在4年期间，三支血管病变患者的再梗死率为32%，而双支和单支血管病变患者分别为14%和11%（P<0.05）。结论是，射血分数小于0.30仅是心肌梗死后第一年心脏死亡和再梗死的主要危险因素。在第一年之后，三支血管病变患者亚组在随后三年有心脏死亡和再梗死的风险。
