Køber L, Torp-Pedersen C, Ottesen M, Burchardt H, Korup E, Lyngborg K
Department of Cardiology P, Gentofte University Hospital of Copenhagen, Denmark.
Am J Cardiol. 1996 Jul 15;78(2):158-62. doi: 10.1016/s0002-9149(96)90389-6.
The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AIM) on long-term mortality in different age groups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patients) were screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV systolic function determined as wall motion index, infarct complications, and survival were documented for all patients. To study the importance of congestive heart failure and wall motion index independent of age, we performed Cox proportional-hazard models in 4 different age strata (< or = 55 years, 56 to 65 years, 66 to 75 years, and > 75 years). Patients in these strata had 1-year mortality rates of 5%, 11%, 21%, and 32%, respectively. Three-year mortality rates were 11%, 20%, 34%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age strata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasing wall motion index were 6.5 (3.6 to 11.4), 3.3 (2.3 to 4.6), 2.7 (2.2 to 3.4), and 2.1 (1.7 to 2.6), respectively. In absolute percentages, there was an excess 3-year mortality associated with congestive heart failure in the 4 age strata of 14%, 24%, 25%, and 28% respectively. The absolute excess in 3-year mortality associated with LV systolic dysfunction in the 4 age strata was 15%, 19%, 25%, and 21%, respectively. Thus, the relative importance of LV systolic dysfunction and congestive heart failure diminished with increasing age. However, the absolute excess mortality associated with congestive heart failure and LV systolic dysfunction was more pronounced in the elderly than in the young.
本研究的目的是评估急性心肌梗死（AIM）后充血性心力衰竭和左心室（LV）收缩功能障碍对不同年龄组长期死亡率的重要性。共有7001例连续的酶学确诊急性心肌梗死患者（6676例患者）被筛选纳入群多普利心脏评估（TRACE）研究。记录了所有患者的病史、通过超声心动图以室壁运动指数确定的LV收缩功能、梗死并发症及生存情况。为了研究独立于年龄之外的充血性心力衰竭和室壁运动指数的重要性，我们在4个不同年龄层（≤55岁、56至65岁、66至75岁和＞75岁）进行了Cox比例风险模型分析。这些年龄层的患者1年死亡率分别为5%、11%、21%和32%。3年死亡率分别为11%、2%、34%和55%。在相同的4个年龄层中，与充血性心力衰竭相关的风险比（及95%置信区间）分别为1.9（1.3至2.9）、2.8（2.1至3.7）、1.8（1.5至2.2）和1.8（1.5至2.2）。与室壁运动指数降低相关的风险比分别为6.5（3.6至11.4）、3.3（2.3至4.6）、2.7（2.2至3.4）和2.1（1.7至2.6）。以绝对百分比计，4个年龄层中与充血性心力衰竭相关的3年额外死亡率分别为14%、24%、25%和28%。4个年龄层中与LV收缩功能障碍相关的3年额外死亡率分别为15%、19%、25%和21%。因此，LV收缩功能障碍和充血性心力衰竭的相对重要性随年龄增长而降低。然而，与充血性心力衰竭和LV收缩功能障碍相关的绝对额外死亡率在老年人中比在年轻人中更显著。
