心肌梗死前心绞痛对老年急性前壁心肌梗死的保护作用研究

目的　观察心肌梗死前 2 4h内心绞痛对老年急性前壁心肌梗死有无保护作用。方法　选择老年急性前壁心肌梗死 10 8例 ,有梗死前心绞痛者为A组 (5 3例 )、无梗死前心绞痛者为B组 (5 5例 ) ,行心电图、心肌酶、超声心动图、核素心血池等检查。对心电图QRS积分值、心肌酶峰值、左室射血分数、心源性休克、室壁瘤形成及短期病死率进行比较。结果　B组心肌梗死患者QRS积分值、心肌酶峰值、心源性休克、室壁瘤形成及 1个月病死率明显高于A组 (P<0 .0 5 ) ,左室射血分数明显低于A组 (P<0 .0 5 )。结论　梗死前 2 4h内心绞痛可减低老年急性心肌梗死时QRS积分值 ,保护心功能 ,降低短期病死率。缺血预处理可能是梗死前心绞痛保护作用的主要机制。

The beneficial effects of antecedent angina pectoris on anterior wall acute myocardial infarction in the elderly patients

Objective To observe whether angina 24 h before anterior wall myocardial infarction provides protection in elderly patients.Methods Retrospective study was carried out to examine whether antecedent angina within 24 h before myocardial infarction exerted a beneficial effect on in hospital outcomes in elderly (≥65 years,n=108) patients.Fifty three cases (group A) had antecedent angina within 24 h of AMI,while fifty five (group B) did not have.QRS score,serum cardiac enzymes,left ventricle ejection fraction (LVEF),left ventricular aneurysm and mortality within one month of hospitalization were compared between the two groups.Results QRS score and serum cardiac enzymes were higher in group B as compared with group A,P< 0.05. In hospital death was more frequent in elderly patients without previous angina than in those with previous angina (14.5% vs.1.9%,P<0.05), as were cardiac shock (14.5% vs.3.8%, P<0.05) and aneurysm (16.4% vs.5.7%,P<0.05). Conclusions The presence of angina 24 h before AMI has significant beneficial effect on in hospital outcomes in elderly patients,suggesting that the protection afforded by angina may involve the occurrence of ischemic preconditioning.