Negus B H, Willard J E, Glamann D B, Landau C, Snyder R W, Hillis L D, Lange R A
Department of Internal Medicine, University of Texas Southerwestern Medical Center, Dallas 75235-9047.
Am J Med. 1994 Apr;96(4):354-8. doi: 10.1016/0002-9343(94)90066-3.
To assess the coronary anatomy and prognosis of young, asymptomatic survivors of myocardial infarction.
The records of all 5,316 patients who underwent cardiac catheterization at Parkland Memorial Hospital from July 1978 to December 1992 were reviewed to identify those patients 40 years old and younger who were catheterized within 60 days of a first myocardial infarction. Of 129 such patients, 48 had no indication for catheterization other than age (group I), and 81 were catheterized for spontaneous or provocable ischemia (group II). Extent of coronary artery disease and long-term follow-up were examined to ascertain the utility of cardiac catheterization in the asymptomatic patients.
The 2 groups were similar with respect to clinical variables. The asymptomatic survivors of infarction (group I) had fewer diseased coronary arteries than did those with post-infarction ischemia (group II) (1.0 +/- 0.7 versus 1.5 +/- 1.0 [mean +/- SD] diseased coronary arteries, respectively; P = 0.002) and were less likely to have left-main or 3-vessel coronary artery disease (4% versus 20%, respectively; P = 0.027). Eighty-three percent of the group I patients had one diseased coronary artery, or less, and no patient underwent angioplasty or coronary bypass grafting on the basis of catheterization. After 71 +/- 44 months of follow-up, only 5 (10%) had died of a coronary-related event.
Asymptomatic survivors of myocardial infarction who are 40 years of age or less rarely have left-main or 3-vessel coronary artery disease, and their long-term prognosis with conservative therapy is good. Routine catheterization in these patients is not warranted and should be reserved for those who manifest spontaneous or provocable post-infarction ischemia.
评估年轻的无症状心肌梗死幸存者的冠状动脉解剖结构及预后情况。
回顾了1978年7月至1992年12月在帕克兰纪念医院接受心脏导管插入术的所有5316例患者的记录，以确定那些年龄在40岁及以下且在首次心肌梗死后60天内接受导管插入术的患者。在这129例此类患者中，48例除年龄外无导管插入术指征（I组），81例因自发性或诱发性缺血而接受导管插入术（II组）。检查冠状动脉疾病的程度及长期随访情况，以确定心脏导管插入术在无症状患者中的实用性。
两组在临床变量方面相似。梗死无症状幸存者（I组）的病变冠状动脉比梗死缺血患者（II组）少（分别为1.0±0.7支与1.5±1.0支病变冠状动脉[均值±标准差]；P = 0.002），且发生左主干或三支冠状动脉疾病的可能性较小（分别为4%与20%；P = 0.027）。I组83%的患者有一支或更少的病变冠状动脉，且没有患者基于导管插入术接受血管成形术或冠状动脉搭桥术。经过71±44个月的随访，只有5例（10%）死于冠状动脉相关事件。
40岁及以下的心肌梗死无症状幸存者很少发生左主干或三支冠状动脉疾病，保守治疗的长期预后良好。这些患者无需常规进行导管插入术，应仅用于那些出现自发性或诱发性梗死后缺血的患者。
