心绞痛诱导的成年和老年患者心肌梗死保护作用：衰老心脏中预处理机制的丧失？

Angina-induced protection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart?

作者信息

Abete P, Ferrara N, Cacciatore F, Madrid A, Bianco S, Calabrese C, Napoli C, Scognamiglio P, Bollella O, Cioppa A, Longobardi G, Rengo F

机构信息

Istituto di Medicina Interna, Cardiologia e Chirurgia Cardiovascolare, Università degli Studi di Napoli Federico II, Naples, Italy.

出版信息

J Am Coll Cardiol. 1997 Oct;30(4):947-54. doi: 10.1016/s0735-1097(97)00256-8.

DOI:10.1016/s0735-1097(97)00256-8

PMID:9316523

Abstract

OBJECTIVES

The present study examined whether angina 48 h before myocardial infarction provides protection in adult and elderly patients.

BACKGROUND

The mortality rate for coronary artery disease is greater in elderly than in young patients. In experimental studies, ischemic preconditioning affords an endogenous form of protection against ischemia-reperfusion injury in adult but not in senescent hearts. Angina before myocardial infarction, a clinical equivalent of experimental ischemic preconditioning, has a protective effect in adult patients. It is not known whether angina before myocardial infarction is also protective in aged patients.

METHODS

We retrospectively verified whether antecedent angina within 48 h of myocardial infarction exerts a beneficial effect on in-hospital outcomes in adult (< 65 years old, n = 293) and elderly (> or = 65 years old, n = 210) patients.

RESULTS

In-hospital death was more frequent in adult patients without than in those with previous angina (10% vs. 2.6%, p < 0.01), as were congestive heart failure or shock (10.7% vs. 3.3%, p < 0.02) and the combined end points (in-hospital death and congestive heart failure or shock) (20.7% vs. 5.9%, p < 0.0003). In contrast, the presence or absence of previous angina before acute myocardial infarction in elderly patients seems not to influence the incidence of in-hospital death (14.4% vs. 15.2%, p = 0.97), congestive heart failure or shock (11.0% vs. 11.9%, p = 0.99) and the combined end points (25.4% vs. 27.1%, p = 0.89). Logistic regression analysis models for in-hospital end points show that previous angina is a positive predictor in adult but not in elderly patients.

CONCLUSIONS

The presence of angina before acute myocardial infarction seems to confer protection against in-hospital outcomes in adults; this effect seemed to be less obvious in elderly patients. This study suggests that the protection afforded by angina in adult patients may involve the occurrence of ischemic preconditioning, which seems to be lost in senescent patients.

摘要

目的

本研究旨在探讨心肌梗死前48小时出现的心绞痛是否能为成年和老年患者提供保护。

背景

老年冠心病患者的死亡率高于年轻患者。在实验研究中，缺血预处理可在成年心脏而非衰老心脏中提供一种内源性的缺血再灌注损伤保护作用。心肌梗死前的心绞痛是实验性缺血预处理的临床等效情况，对成年患者有保护作用。目前尚不清楚心肌梗死前的心绞痛对老年患者是否也有保护作用。

方法

我们回顾性验证了心肌梗死48小时内出现的前驱心绞痛对成年（<65岁，n = 293）和老年（≥65岁，n = 210）患者住院结局是否有有益影响。

结果

无既往心绞痛的成年患者住院死亡率高于有既往心绞痛的患者（10%对2.6%，p < 0.01），充血性心力衰竭或休克发生率也是如此（10.7%对3.3%，p < 0.02），以及综合终点（住院死亡和充血性心力衰竭或休克）（20.7%对5.9%，p < 0.0003）。相比之下，老年患者急性心肌梗死前是否有既往心绞痛似乎不影响住院死亡率（14.4%对15.2%，p = 0.97）、充血性心力衰竭或休克发生率（11.0%对11.9%，p = 0.99）以及综合终点（25.4%对27.1%，p = 0.89）。住院终点的逻辑回归分析模型显示，既往心绞痛是成年患者住院结局的阳性预测因素，但在老年患者中并非如此。