Hugenholtz P G, Fioretti P, Simoons M L, Serruys P W, Roelandt J R, Lubsen J
Can J Cardiol. 1986 Nov-Dec;2(6):345-52.
Immediately after the first signs and symptoms of acute myocardial infarction are detected, its prognosis is determined by the size of the area at risk, the availability of collaterals and the time at which interventions are carried out. Preservation of as much myocardial tissue as possible is the key issue. Relief of obstruction of the thrombosed nutrient artery and reperfusion of the myocardium in jeopardy within 4 hours after onset of symptoms can lead to limitation of the ultimate infarct size, maintained ventricular function and a marked reduction of the first year mortality. Early supportive therapy with beta-blockade and calcium antagonists may enhance this effect. Recent data published on 533 patients randomized to either a reperfusion strategy or to conventional therapy, combined with those from the recent literature on thrombolysis and early beta blockade, provide the basis for this point of view. Once infarction is unavoidable and in the process of consolidation, supportive therapy is recommended. This still can change the outcome by timely correction of electrical instability, normalization of afterload and heart-rate, and the avoidance of secondary complications such as peripheral thrombosis. To determine the best course after recovery from the infarction, a symptom limited bicycle stress test, radionuclide ventriculography and 24 hour ambulatory electrocardiogram at the time of discharge were compared in predicting one year survival in 351 hospital survivors. A history of previous myocardial infarction or of heart failure during the current episode proved to be the strongest clinical predictor of early death.(ABSTRACT TRUNCATED AT 250 WORDS)
在首次检测到急性心肌梗死的体征和症状后，其预后取决于危险区域的大小、侧支循环的情况以及采取干预措施的时间。尽可能保留更多的心肌组织是关键问题。在症状发作后4小时内解除血栓形成的营养动脉阻塞并使处于危险中的心肌再灌注，可限制最终梗死面积，维持心室功能并显著降低第一年死亡率。早期使用β受体阻滞剂和钙拮抗剂进行支持性治疗可能会增强这种效果。最近发表的关于533例随机接受再灌注策略或传统治疗的患者的数据，以及最近关于溶栓和早期β受体阻滞剂的文献数据，为这一观点提供了依据。一旦梗死不可避免且处于巩固过程中，建议进行支持性治疗。这仍可通过及时纠正电不稳定、使后负荷和心率正常化以及避免外周血栓形成等继发性并发症来改变预后。为了确定梗死后恢复后的最佳治疗方案，对351例出院患者进行了症状限制性自行车运动试验、放射性核素心室造影和出院时24小时动态心电图检查，以比较它们对1年生存率的预测情况。既往有心肌梗死病史或本次发作期间有心力衰竭病史被证明是早期死亡最强的临床预测因素。（摘要截短至250字）
