Bounhoure J P, Galinier M, Puel J, Assoun B, Albenque J P, Marco F, Fauvel J M
Service de cardiologie clinique et expérimentale, CHU Toulouse-Rangueil, université Paul-Sabatier.
Arch Mal Coeur Vaiss. 1995 Jun;88(6):817-22.
Between 1977 and 1990, 64 premenopausal women, under 50 years of age (42 +/- 5.6 years), were admitted for typical acute myocardial infarction with pathological Q waves. Twenty one patients had attempted myocardial revascularisation either by intravenous thrombolysis or primary angioplasty (n = 3). All patients underwent coronary angiography with selective left ventriculography during their hospital admission. This group of 64 women was characterised by the association of coronary risk factors (2.8 per patient): smoking (89%), hyperlipidaemia (67%), diabetes (45%) and oral contraception (35%). Coronary angiography showed single vessel occlusion in 86% of patients receiving oral contraception, multiple vessel disease in 36.5% and single or double vessel disease in 31.7% of the other patients. There were 3 deaths during the hospital period (4.6%), 12 cases of left ventricular failure, 2 ventricular aneurysms, 2 operated ischaemic mitral regurgitations and 9 recurrences of pain treated by angioplasty. During follow-up (36.5 +/- 4 months), 22 patients were readmitted to hospital and there were 3 further deaths, 12 cases of persistent cardiac failure, 10 cases of latent ventricular dysfunction and 9 ischaemic reoccurrences treated by angioplasty or surgery. The results in this group of patients suffering from myocardial infarction at an unusually early age for women showed that although the mortality was similar to that observed in men of the same age (9%) there was a very high morbidity and a high risk of cardiac failure. The prognosis of myocardial infarction in women, though better than 10 years ago, should improve with immediate revascularisation, the correction of cardiovascular risk factors and the rapid application of all techniques of modern cardiology.
1977年至1990年间，64名50岁以下（平均年龄42±5.6岁）的绝经前女性因典型急性心肌梗死伴病理性Q波入院。21例患者曾尝试通过静脉溶栓或直接血管成形术进行心肌血运重建（其中3例接受直接血管成形术）。所有患者在住院期间均接受了冠状动脉造影及选择性左心室造影。这64名女性患者具有多种冠心病危险因素（平均每人2.8种）：吸烟（89%）、高脂血症（67%）、糖尿病（45%）及口服避孕药（35%）。冠状动脉造影显示，服用口服避孕药的患者中86%为单支血管闭塞，其他患者中36.5%为多支血管病变，31.7%为单支或双支血管病变。住院期间有3例死亡（4.6%），12例发生左心室衰竭，2例出现室壁瘤，2例接受手术治疗的缺血性二尖瓣反流，9例疼痛复发接受血管成形术治疗。在随访期间（平均36.5±4个月），22例患者再次入院，又有3例死亡，12例持续存在心力衰竭，10例存在潜在心室功能障碍，9例缺血复发接受血管成形术或手术治疗。这组女性患者在异常年轻时发生心肌梗死的结果表明，尽管死亡率与同龄男性相似（9%），但发病率非常高且心力衰竭风险高。女性心肌梗死的预后虽然比10年前有所改善，但通过立即血运重建、纠正心血管危险因素以及迅速应用现代心脏病学的所有技术，预后应会进一步改善。
