摘要
目的 :探讨急性心肌梗死 (AMI)伴先前性心绞痛 (AP)患者的冠状动脉 (冠脉 )病变特点及临床预后。方法 :在连续急诊冠脉造影的 385例AMI患者中分析伴有AP(AP组 ,2 0 2例 )及无AP者 (Non AP组 ,183例 )的临床资料与冠脉病变特征 ,并平均随访 (2 8.7± 8.2 )个月主要心血管事件 (包括反复心绞痛发作、非致命性心肌梗死、非致命性心力衰竭、靶血管血运重建及心脏性死亡 )和复合终点事件的发生率。结果 :与Non AP组比较 ,AP组肌酸激酶 (CK)及其同工酶 (CK MB)峰值均显著降低 [(196 5± 14 2 2 )∶(312 6± 2 10 8) ;(81± 4 6 )∶(118± 5 6 )IU/L ,均P <0 .0 1],但其三支病变及伴左主干病变者较多 (33.2 %∶16 .9% ;8.9%∶3.6 % ,均P <0 .0 5 ) ,随访期间AMI后反复心绞痛发作与心脏性死亡率较高 (36 .2 %∶2 3.6 % ,P <0 .0 1;10 .2 %∶3.6 % ,P <0 .0 5 ) ,复合终点事件明显增加 (4 8.0 %∶30 .0 % ,P <0 .0 1)。多元Logistic回归分析示AP与AMI患者死亡危险 (OR值 :3.96 ,95 %CI :2 .2 5～ 7.34,P <0 .0 5 )及复合终点事件 (OR值 :3.2 2 ,95 %CI:1.82～ 8.74 ,P <0 .0 1)增加独立相关。结论 :AMI有AP者 ,其冠脉病变多较重 。
Objective:To evaluate the clinical outcomes in acute myocardial infarction (AMI) patients with previous angina pectoris(AP).Methods:Three hundred and eighty five cases with AMI were consecutively underwent coronary angiography and divided into AP group in 202 patients and Non AP group in 183 patients. The clinical and angiographic characteristics were analyzed and the major adverse cardiac events(including presence of recurrent angina, occurrence of non fatal myocardial infarction, nonfatal congestive heart failure, revascularization of target vessels and cardiac related death) were followed up in some cases at the mean duration of ( 28.7 ± 8.2 ) months after the acute epsiode.Results:Compared with Non AP group, the peak value of creatine kinase(CK) and CK MB were lower[(1965±1422) vs (3126±2108);(81±46) vs (118±56)IU/L,all P< 0.01 ],but the incidence of triplevessel disease and left main coronary artery disease were higher( 33.2 % vs 16.9 %; 8.9 % vs 3.3 %,all P< 0.05 ).The follow up result showed there were more incidence of recurrent angina pectoris, higher cardiac mortality and increased combined events in AP group( 36.2 %, 10.2 %, 48.0 % respectively ) than in Non Ap group( 23.6 %,P< 0.01 ; 3.6 %,P< 0.05 ; 30.0 %,P< 0.01 , respec tively).Multivariate logistic regression analysis indicated that previous angina pectoris was an independent determinant of the risk of mortality(OR: 3.96 ,95% CI: 2.25 }7.34,P< 0.05 ) and increase in combined endpoint events(OR: 3.22 ,95% CI: 1.82 8.74 ,P< 0.05 ) in patients with AMI.Conclusion:The AMI patients with previous AP have extensive coronary artery lesions and poor clinical outcomes.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2003年第8期461-463,共3页
Journal of Clinical Cardiology
基金
卫生部属医疗机构临床学科重点项目资助 (No .2 0 0 110 14 )
关键词
心肌梗死
心绞痛
冠状动脉造影
预后
Myocaedial infarction
Angina pectoris
Coronary,angiography
Prognosis
