Jelinek V M, McDonald I G, Ryan W F, Ziffer R W, Clemens A, Gerloff J
Br Med J (Clin Res Ed). 1982 Jan 23;284(6311):227-30. doi: 10.1136/bmj.284.6311.227.
A total of 188 patients with uncomplicated acute myocardial infarction (long-term Norris prognostic index 3.2) were rapidly mobilised, underwent a symptom-limited exercise test around the day of discharge from hospital (day 10), and returned to work at a median of six weeks after the acute event. The incidence of cardiac death six months, one year, and three years after infarction was 2.7%, 4.5%, and 7.3% respectively, and the corresponding figures for recurrent heart attacks were 3.4%, 8.2%, and 18.5% respectively. The risk of recurrence of heart attack was predicted by three variables assessed at discharge--namely, a history of classical effort angina (p less than 0.01), radiological heart failure (p less than 0.05), and angina induced by the exercise test (p less than 0.05). The presence of any of these risk factors defined a group of patients with a sevenfold risk of recurrent heart attacks within six months of the initial acute infarct. It is concluded that these risk factors identify a group of patients with a high risk of recurrence early after infarction, in whom vigorous secondary prophylaxis is desirable.
总共188例无并发症急性心肌梗死患者（长期诺里斯预后指数为3.2）被迅速动员起来，在出院当天（第10天）左右接受了症状限制性运动试验，并在急性事件发生后的中位六周后重返工作岗位。心肌梗死后六个月、一年和三年的心脏死亡发生率分别为2.7%、4.5%和7.3%，复发性心脏病发作的相应数字分别为3.4%、8.2%和18.5%。出院时评估的三个变量可预测心脏病发作复发风险，即典型劳力性心绞痛病史（p<0.01）、放射性心力衰竭（p<0.05）和运动试验诱发的心绞痛（p<0.05）。这些危险因素中的任何一个的存在都定义了一组患者，他们在初次急性梗死的六个月内复发性心脏病发作的风险增加了七倍。结论是，这些危险因素可识别出一组心肌梗死后早期复发风险高的患者，对他们进行积极的二级预防是可取的。
