Loh E, Sutton M S, Wun C C, Rouleau J L, Flaker G C, Gottlieb S S, Lamas G A, Moyé L A, Goldhaber S Z, Pfeffer M A
Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
N Engl J Med. 1997 Jan 23;336(4):251-7. doi: 10.1056/NEJM199701233360403.
In patients who have had a myocardial infarction, the long-term risk of stroke and its relation to the extent of left ventricular dysfunction have not been determined. We studied whether a reduced left ventricular ejection fraction is associated with an increased risk of stroke after myocardial infarction and whether other factors such as older age and therapy with anticoagulants, thrombolytic agents, or captopril affect long-term rates of stroke.
We performed an observational analysis of prospectively collected data on 2231 patients who had left ventricular dysfunction after acute myocardial infarction who were enrolled in the Survival and Ventricular Enlargement trial. The mean follow-up was 42 months. Risk factors for stroke were assessed by both univariate and multivariate Cox proportional-hazards analysis.
Among these patients, 103 (4.6 percent) had fatal or nonfatal strokes during the study (rate of stroke per year of follow-up, 1.5 percent). The estimated five-year rate of stroke in all the patients was 8.1 percent. As compared with patients without stroke, patients with stroke were older (mean [+/-SD] age, 63+/-9 years vs. 59+/-11 years; P<0.001) and had lower ejection fractions (29+/-7 percent vs. 31+/-7 percent, P=0.01). Independent risk factors for stroke included a lower ejection fraction (for every decrease of 5 percentage points in the ejection fraction there was an 18 percent increase in the risk of stroke), older age, and the absence of aspirin or anticoagulant therapy. Patients with ejection fractions of < or = 28 percent after myocardial infarction had a relative risk of stroke of 1.86, as compared with patients with ejection fractions of more than 35 percent (P=0.01). The use of thrombolytic agents and captopril had no significant effect on the risk of stroke.
During the five years after myocardial infarction, patients have a substantial risk of stroke. A decreased ejection fraction and older age are both independent predictors of an increased risk of stroke. Anticoagulant therapy appears to have a protective effect against stroke after myocardial infarction.
在心肌梗死患者中，中风的长期风险及其与左心室功能障碍程度的关系尚未明确。我们研究了左心室射血分数降低是否与心肌梗死后中风风险增加相关，以及其他因素，如老年、抗凝剂、溶栓剂或卡托普利治疗是否影响中风的长期发生率。
我们对参与生存与心室扩大试验的2231例急性心肌梗死后出现左心室功能障碍的患者前瞻性收集的数据进行了观察性分析。平均随访时间为42个月。通过单变量和多变量Cox比例风险分析评估中风的危险因素。
在这些患者中，103例（4.6%）在研究期间发生了致命或非致命性中风（随访每年中风发生率为1.5%）。所有患者的估计五年中风发生率为8.1%。与未发生中风的患者相比，发生中风的患者年龄更大（平均[±标准差]年龄，63±9岁对59±11岁；P<0.001）且射血分数更低（29±7%对31±7%，P=0.01）。中风的独立危险因素包括较低的射血分数（射血分数每降低5个百分点，中风风险增加18%）、老年以及未使用阿司匹林或抗凝治疗。心肌梗死后射血分数≤28%的患者中风相对风险为1.86，而射血分数超过35%的患者为1.86（P=0.01）。使用溶栓剂和卡托普利对中风风险无显著影响。
在心肌梗死后的五年中，患者有相当大的中风风险。射血分数降低和老年都是中风风险增加的独立预测因素。抗凝治疗似乎对心肌梗死后的中风有保护作用。
