Køber L, Torp-Pedersen C, Jørgensen S, Eliasen P, Camm A J
Department of Cardiology P, Gentofte University Hospital of Copenhagen, Denmark.
Am J Cardiol. 1998 Jun 1;81(11):1292-7. doi: 10.1016/s0002-9149(98)00158-1.
Changes in the importance of left ventricular (LV) systolic dysfunction and congestive heart failure (CHF) with time after an acute myocardial infarction (AMI) after the introduction of thrombolytic therapy have not been studied. LV systolic function, measured as wall motion index (WMI) by echocardiography, was assessed in 6,676 consecutive patients with an enzyme-confirmed AMI. So that changes in the prognostic value of WMI or CHF could be studied, separate analyses were performed at selected time periods. Average monthly mortality (deaths per 100 patients per month) was determined from life-table analyses, with groups divided by WMI above and below 1.2 (a WMI > 1.2 corresponds to an ejection fraction > 0.35) or by presence and/or absence of CHF. Relative risk (95% confidence intervals [CI]) was determined by proportional hazard models, including baseline characteristics. In patients with LV dysfunction or CHF, monthly mortality was high during the first month (18.3 +/- 1.6% and 20.2 +/- 1.6%, respectively), decreased during the first year, and was stable thereafter (0.8 +/- 0.1% and 1.0 +/- 0.1%, respectively, average monthly mortality after year 3). The relative risk of LV dysfunction decreased from 2.4 (CI 2.0 to 2.9) to 1.3 (CI 1.0 to 1.6) in the same period. The relative risk of CHF decreased from 2.9 (CI 2.3 to 3.8) to 1.6 (CI 1.3 to 2.0). In patients without LV dysfunction or CHF, monthly mortality was relatively high during the first month (5.2% +/- 0.7% and 3.4% +/- 0.6%, respectively) but decreased within the first year to low, stable values (0.6% +/- 0.1% and 0.4% +/- 0.1%, respectively, average monthly mortality after year 3). In patients who received thrombolytic therapy, the relative risk associated with a WMI < or = 1.2 decreased from 3.0 (CI 2.0 to 4.4) to 1.3 (CI 0.9 to 1.6) and from 3.2 (CI 2.0 to 5.1) to 1.7 (CI 1.2 to 2.4) in patients with CHF. The risk of dying decreases steeply with time after an AMI with or without LV dysfunction or CHF and stabilizes at low values after 1 year. This is in contrast to the relative importance of these risk factors, which is maintained for > or = 5 years but decreases with time.
溶栓治疗引入后，急性心肌梗死（AMI）后左心室（LV）收缩功能障碍和充血性心力衰竭（CHF）的重要性随时间的变化尚未得到研究。通过超声心动图测量的左室收缩功能，以室壁运动指数（WMI）评估，在6676例酶学确诊的急性心肌梗死患者中进行。为了研究WMI或CHF预后价值的变化，在选定的时间段进行了单独分析。平均每月死亡率（每月每100例患者的死亡数）通过生命表分析确定，根据WMI高于或低于1.2（WMI>1.2对应射血分数>0.35）或是否存在CHF进行分组。相对风险（95%置信区间[CI]）通过比例风险模型确定，包括基线特征。在左室功能障碍或CHF患者中，第一个月的每月死亡率较高（分别为18.3±1.6%和20.2±1.6%），在第一年下降，此后保持稳定（分别为0.8±0.1%和1.0±0.1%，第3年后的平均每月死亡率）。同期左室功能障碍的相对风险从2.4（CI 2.0至2.9）降至1.3（CI 1.0至1.6）。CHF的相对风险从2.9（CI 2.3至3.8）降至1.6（CI 1.3至2.0）。在无左室功能障碍或CHF的患者中，第一个月的每月死亡率相对较高（分别为5.2%±0.7%和3.4%±0.6%），但在第一年内降至低水平并保持稳定（分别为0.6%±0.1%和0.4%±0.1%，第3年后的平均每月死亡率）。在接受溶栓治疗的患者中，CHF患者中WMI≤1.2相关的相对风险从3.0（CI 2.0至4.4）降至1.3（CI 0.9至1.6），从3.2（CI 2.0至5.1）降至1.7（CI 1.2至2.4）。无论有无左室功能障碍或CHF，急性心肌梗死后死亡风险随时间急剧下降，并在1年后稳定在低水平。这与这些危险因素的相对重要性形成对比，其相对重要性在≥5年内维持，但随时间降低。
