Ahnve S, Gilpin E, Dittrich H, Nicod P, Henning H, Carlisle J, Ross J
Division of Cardiology, University of California, San Diego Medical Center, La Jolla 92093.
Am Heart J. 1988 Oct;116(4):925-32. doi: 10.1016/0002-8703(88)90142-1.
This study examines patients with a first myocardial infarction (MI) (about 70% of the population, n = 2089), and identifies factors associated with 1-year cardiac mortality in patients discharged alive. With the use of multivarate analysis of variables observed at hospital discharge in patients with a first MI, age was the most important predictor, followed by left ventricular ejection fraction (LVEF) (determined in 56%) and other variables. Based on this finding, age subsets (less than or equal to 50, 51 to 70, greater than 70 years) were related to LVEF groups (less than or equal to 0.40, 0.41 to 0.50, greater than 0.50). Patients with a first MI who were less than 50 years of age with LVEF greater than 0.40 and patients between 51 and 70 years of age with LVEF greater than 0.50 had a very low risk for 1-year cardiac death, 1.2 +/- 1.1% (95% confidence interval). Such patients comprised 47% of individuals with a first MI having an LVEF determination. Mortality in the remaining patients less than 70 years was 7.4 +/- 3.5%. Mortality for patients greater than 70 years was high, 22.2 +/- 6.6%. Thus with LVEF as the only predischarge test, a sizable low risk group can be identified among patients with a first MI.
本研究对首次发生心肌梗死（MI）的患者（约占总体的70%，n = 2089）进行了检查，并确定了存活出院患者1年心脏死亡率的相关因素。通过对首次心肌梗死患者出院时观察到的变量进行多变量分析，年龄是最重要的预测因素，其次是左心室射血分数（LVEF）（56%的患者进行了此项测定）及其他变量。基于这一发现，年龄亚组（小于或等于50岁、51至70岁、大于70岁）与LVEF分组（小于或等于0.40、0.41至0.50、大于0.50）相关。首次心肌梗死且年龄小于50岁、LVEF大于0.40的患者，以及年龄在51至70岁、LVEF大于0.50的患者，1年心脏死亡风险极低，为1.2±1.1%（95%置信区间）。此类患者占首次心肌梗死且进行了LVEF测定患者的47%。其余小于70岁患者的死亡率为7.4±3.5%。大于70岁患者的死亡率很高，为22.2±6.6%。因此，以LVEF作为唯一的出院前检查，在首次心肌梗死患者中可识别出相当大的低风险组。
