Kothe K, Aurisch R, Porstmann B
Universitätsklinik für Innere Medizin, Bereiches Medizin (Charité) der Humboldt-Universität zu Berlin.
Z Alternsforsch. 1989 Sep-Oct;44(5):257-66.
The percentage of older patients with AMI in the total of patients is predominating and is still increasing differentiatedly. The essential cause of there is an increase in complications and in mortality until the 28th day. In a prospective study over 48 months with n = 390 patients we analyzed the age groups less than 65 years (A) and greater than or equal to 65 years (B) regarding their different rates of complications. For the semiquantitative determination of myocardial infarction sizes we used: -Monitoring of ECG, creatinine kinase (CK), and ejection fraction global (EFg). In group A 81% survived, whereas in group B only 60% survived. The average age of the surviving patients was 56.2 years, that of the deceased 64.4 years. The percentage of surviving patients with transmural AMI was 96% in A and 57% in B. In both A and B. CKmax with p less than 0.01 was to be differentiated between non-transmural and transmural AMI. In the deceased CKmax was 89.7 (A) to 59.3 mumol/lxs (B) (p less than 0.05). The percentage with AMI extension was 4% in A and 43% in B, p less than 0.005. Patients of group B showed a significant difference (p less than 0.001) of EFg for non-transmural AMI 59.1 (36-70)%, transmural AMI 31.5%, and deceased 17.3%. In patients with Re-AMI EFg was generally measured to be less than 45%. Re-AMI could be diagnosed in 13% of A and in 29% of B (p less than 0.001). The ICU stay of the surviving patients of the total number of patients could be reduced by 1.1 days in the period from 1984 through 1987. With group B it could be reduced by 0.8 days. The overall stay in hospital (1984-1987) was 19.6 days (A = 18.3; B = 22.4). AMI extension and the Re-AMI result are the decivise factors to the essential increase in complications and cases of death with AMI at older age. The semiquantitative determination of the myocardial infarction size by monitoring makes up an efficient basis for the early assessment of the residual function of the myocardium and of the risk classification.
老年急性心肌梗死（AMI）患者在全部患者中所占比例居主导地位，且仍在差异化增加。其根本原因是直至第28天并发症和死亡率均有所上升。在一项为期48个月、纳入390例患者的前瞻性研究中，我们分析了年龄小于65岁（A组）和大于或等于65岁（B组）的患者的不同并发症发生率。对于心肌梗死面积的半定量测定，我们采用：-心电图监测、肌酐激酶（CK）以及整体射血分数（EFg）。A组81%的患者存活，而B组仅60%存活。存活患者的平均年龄为56.2岁，死亡患者为64.4岁。透壁性AMI存活患者的比例在A组为96%，在B组为57%。在A组和B组中，非透壁性和透壁性AMI的CKmax均有差异（p<0.01）。死亡患者的CKmax为89.7（A组）至59.3μmol/l·s（B组）（p<0.05）。AMI扩展的比例在A组为4%，在B组为43%，p<0.005。B组患者在非透壁性AMI时的EFg为59.1（36 - 70）%，透壁性AMI时为31.5%，死亡患者为17.3%，差异有统计学意义（p<0.001）。再发AMI患者的EFg一般测量值小于45%。再发AMI在A组的诊断率为13%，在B组为29%（p<0.001）。1984年至1987年期间，全部患者中存活患者的重症监护病房（ICU）住院时间可缩短1.1天。B组可缩短0.8天。总体住院时间（1984 - 1987年）为19.6天（A组 = 18.3天；B组 = 22.4天）。AMI扩展和再发AMI结果是老年AMI患者并发症和死亡病例显著增加的决定性因素。通过监测进行心肌梗死面积的半定量测定为早期评估心肌残余功能和风险分级提供了有效依据。
