Cabin H S, Roberts W C
Am J Cardiol. 1982 Oct;50(4):677-81. doi: 10.1016/0002-9149(82)91218-8.
Clinical and necropsy observations are described in 61 patients with a healed transmural myocardial infarction, 33 with and 28 without a clinical history of acute myocardial infarction. There were no significant differences between the 2 groups of patients in mean age, sex, or frequency of angina pectoris, chronic congestive heart failure, systemic hypertension, sudden coronary death, or fatal acute myocardial infarction. Compared with the patients with clinically recognized acute myocardial infarction, the patients with clinically unrecognized (silent) infarction had a significantly (p less than 0.05) higher incidence of diabetes mellitus (43 versus 15%), death from noncardiac causes (39 versus 9%), posterior (inferior) wall infarcts (82 versus 55%), and smaller infarcts (mean size 7 versus 17% of left ventricular wall). The patients with and without clinically recognized infarction had similar numbers of the 4 major coronary arteries severely (76 to 100% in cross-sectional area) narrowed (mean 2.8 versus 2.9/4.0 per patient), insignificant differences in incidence of severe narrowing of the left main coronary artery (18 versus 29%), similar overall percents of 5 mm segments of the 4 major coronary arteries severely narrowed (43 versus 42%), and similar percents of severely narrowed 5 mm segments of the right (46 versus 55%), left anterior descending (39 versus 33%), and left circumflex (41 versus 41%) coronary arteries.
本文描述了61例透壁性心肌梗死已愈合患者的临床和尸检观察结果，其中33例有急性心肌梗死病史，28例无急性心肌梗死病史。两组患者在平均年龄、性别、心绞痛、慢性充血性心力衰竭、系统性高血压、心源性猝死或致命性急性心肌梗死的发生率方面无显著差异。与有临床诊断急性心肌梗死的患者相比，无临床诊断（无症状）梗死的患者糖尿病发生率显著更高（43%对15%，p<0.05），非心脏原因导致的死亡发生率更高（39%对9%），后壁（下壁）梗死发生率更高（82%对55%），梗死面积更小（平均大小为左心室壁的7%对17%）。有和无临床诊断梗死的患者严重狭窄（横截面积76%至100%）的4支主要冠状动脉数量相似（平均每位患者2.8支对2.9支/4.0支），左主干冠状动脉严重狭窄发生率无显著差异（18%对29%），4支主要冠状动脉5mm节段严重狭窄的总体百分比相似（43%对42%），右冠状动脉（46%对55%）、左前降支（39%对33%）和左旋支（41%对41%）冠状动脉5mm节段严重狭窄的百分比相似。
