Piombo A C, Gagliardi J A, Ulmete E R, Ramos A O, Bertolasi C A
Division of Cardiology, Hospital Municipal Dr. Cosme Argerich, Buenos Aires, Argentina.
Clin Cardiol. 1995 Mar;18(3):157-60. doi: 10.1002/clc.4960180310.
Recurrent ischemia after acute myocardial infarction (AMI) has been largely associated with a poor prognosis. This study was carried out to analyze the relationship among different clinical variables and both postinfarction angina and reinfarction after AMI. A total of 452 consecutive patients (mean age 58.2 +/- 12 years) were admitted to the coronary care unit and were studied prospectively. More than half of the patients received some type of thrombolytic therapy. Death occurred in 45 patients (9.9%) during hospital stay. Postinfarction angina was diagnosed in 81 patients (17.9%) and reinfarction in 22 (4.9%). Patients who developed reinfarction had a high mortality rate (45.5%) compared with those who did not develop such an event (8.1%) (p < 0.0001; odds ratio: 9.4; 95% confidence interval 3.5-25.4). On the other hand, postinfarction angina had no significant association with mortality. Multivariate analysis revealed that a history of angina (> 1 week) was predictive of the occurrence of postinfarction angina and that the use of fibrinolytic treatment, prodromal symptoms, and postinfarction angina were significantly related to reinfarction. We conclude that several simple clinical variables are clear independent predictors of postinfarction angina and reinfarction following AMI and should be taken into account in routine clinical practice or when planning intervention trials.
急性心肌梗死（AMI）后反复出现缺血与预后不良密切相关。本研究旨在分析不同临床变量与AMI后梗死相关心绞痛及再梗死之间的关系。共有452例连续患者（平均年龄58.2±12岁）入住冠心病监护病房并进行前瞻性研究。超过半数的患者接受了某种类型的溶栓治疗。45例患者（9.9%）在住院期间死亡。81例患者（17.9%）被诊断为梗死相关心绞痛，22例（4.9%）发生再梗死。发生再梗死的患者死亡率较高（45.5%），而未发生此类事件的患者死亡率为8.1%（p<0.0001；优势比：9.4；95%置信区间3.5 - 25.4）。另一方面，梗死相关心绞痛与死亡率无显著关联。多因素分析显示，心绞痛病史（>1周）可预测梗死相关心绞痛的发生，而溶栓治疗的使用、前驱症状及梗死相关心绞痛与再梗死显著相关。我们得出结论，几个简单的临床变量是AMI后梗死相关心绞痛和再梗死明确的独立预测因素，在常规临床实践或规划干预试验时应予以考虑。
