Schulman S P, Achuff S C, Griffith L S, Humphries J O, Taylor G J, Mellits E D, Kennedy M, Baumgartner R, Weisfeldt M L, Baughman K L
Divison of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Am Coll Cardiol. 1988 Jun;11(6):1164-72. doi: 10.1016/0735-1097(88)90277-x.
The prognostic variables from predischarge coronary angiography and left ventriculography in survivors of acute myocardial infarction during the years 1974 to 1978 were evaluated in 143 patients (less than or equal to 66 years of age) with documented myocardial infarction who were then followed up prospectively for 5 years. One half of the study population had triple vessel coronary disease (greater than or equal to 50% stenosis). However, only 7% of patients had severely depressed left ventricular function with an ejection fraction less than or equal to 29%. Evaluation of the contribution of many clinical and angiographic variables to a first cardiac event (death, nonfatal reinfarction or coronary artery bypass surgery) was considered with Kaplan-Meier actuarial curves and multivariate Cox's hazard function analysis. A risk segment was defined as an area of contracting myocardium supplied by a coronary artery with a greater than 50% stenosis. Multivariate analysis demonstrated that right plus left anterior descending coronary artery stenoses (p less than 0.01), ejection fraction (p less than 0.01) and the presence of risk segments (p less than 0.05) were significant predictors of outcome. Furthermore, on separate multivariate analyses, the angiographic variables added significantly to the clinical variables to predict cardiac events over 5 years of follow-up. Therefore, in survivors of acute myocardial infarction who undergo cardiac catheterization, additive prognostic information is obtained that can be used to stratify risk over 5 years.
对1974年至1978年间急性心肌梗死幸存者出院前冠状动脉造影和左心室造影的预后变量进行了评估，研究对象为143例（年龄小于或等于66岁）有心肌梗死记录的患者，随后对其进行了为期5年的前瞻性随访。研究人群中有一半患有三支血管冠状动脉疾病（狭窄程度大于或等于50%）。然而，只有7%的患者左心室功能严重受损，射血分数小于或等于29%。采用Kaplan-Meier精算曲线和多变量Cox风险函数分析，评估了许多临床和血管造影变量对首次心脏事件（死亡、非致命性再梗死或冠状动脉搭桥手术）的影响。风险节段定义为由狭窄程度大于50%的冠状动脉供血的收缩心肌区域。多变量分析表明，右冠状动脉加左前降支冠状动脉狭窄（p<0.01）、射血分数（p<0.01）和风险节段的存在（p<0.05）是预后的重要预测因素。此外，在单独的多变量分析中，血管造影变量在5年随访期间对预测心脏事件的临床变量有显著补充作用。因此，在接受心导管检查的急性心肌梗死幸存者中，可获得额外的预后信息，用于对5年风险进行分层。
