Campbell S, A'Hern R, Quigley P, Vincent R, Jewitt D, Chamberlain D
Cardiac Department, King's College Hospital, London, U.K.
Eur Heart J. 1988 Sep;9(9):938-47. doi: 10.1093/oxfordjournals.eurheartj.a062598.
A consecutive series of 559 hospital survivors of acute myocardial infarction aged less than 66 years were studied; 93 were designated prospectively as low-risk because they were suitable for early submaximal exercise testing and had none of the following clinical or exercise test 'risk factors': (1) angina for at least one month prior to infarction; (2) symptomatic ventricular arrhythmias, or (3) recurrent ischaemic pain, both after the first 24 h of infarction; (4) cardiac failure; (5) cardiomegaly; and (6) an abnormal exercise test (angina, ST-depression or poor blood pressure response). Altogether 301 patients were exercised; their mortality over a median follow-up of 2.4 years was 10.2%, versus 24.6% in the 258 patients not exercised (P = 0.0005). Absence of clinical 'risk factors' alone, in the exercised patients, identified 156 with a mortality of 5.4% versus 15.6% in the 145 with at least one clinical 'risk factor' (P = 0.004). The fully defined low-risk group comprised 93 of the former patients who had neither clinical nor exercise test 'risk factors'. None of these patients died compared with 19 of those with at least one 'risk factor' (mortality = 14.7%; P = 0.002). Their respective rates of non-fatal reinfarction were similar and never exceeded 5% per annum. Therefore, simple clinical and exercise test criteria can positively identify low-risk patients after infarction in whom secondary prevention may be inappropriate.
对559名年龄小于66岁的急性心肌梗死住院幸存者进行了一项连续性研究；其中93人被前瞻性地指定为低风险患者，因为他们适合早期次极量运动试验，且没有以下任何临床或运动试验“风险因素”：（1）梗死前至少一个月的心绞痛；（2）有症状的室性心律失常，或（3）梗死最初24小时后反复出现的缺血性疼痛；（4）心力衰竭；（5）心脏扩大；以及（6）异常运动试验（心绞痛、ST段压低或血压反应不佳）。共有301名患者进行了运动；在中位随访2.4年期间，他们的死亡率为10.2%，而258名未运动患者的死亡率为24.6%（P = 0.0005）。仅在运动患者中，没有临床“风险因素”的156人死亡率为5.4%，而至少有一个临床“风险因素”的145人死亡率为15.6%（P = 0.004）。完全定义的低风险组包括93名既没有临床也没有运动试验“风险因素”的前一组患者。这些患者中无人死亡，而至少有一个“风险因素”的患者中有19人死亡（死亡率 = 14.7%；P = 0.002）。他们各自的非致命性再梗死率相似，每年从未超过5%。因此，简单的临床和运动试验标准可以明确识别出梗死后二级预防可能不适用的低风险患者。
