老年高血压合并急性心肌梗死的临床研究

目的探讨老年高血压(HT)合并急性心肌梗死(AMI)的临床特点。方法对比分析82例老年HT合并AMI和64例无高血压(NHT)的老年AMI患者的临床资料。结果两组患者脉压、无痛性心肌梗死、并发症、住院病死率等方面比较差异有统计学意义(P0.05)。结论老年HT合并AMI患者脉压差大,无痛性心肌梗死发病率高,左室肥厚、心力衰竭、心律失常并发症发生率高,住院病死率高,近期预后差。     

急性心肌梗死早期伴发二尖瓣关闭不全对患者预后影响

目的:探讨急性心肌梗死(AMI)患者伴发二尖瓣关闭不全(MR)的临床意义及预后。方法:将2年来我院收治的AMI患者145例分为MR组与no-MR组;根据梗死部位分为前壁AMI组与下壁AMI组,前、下壁各组又根据是否伴发MR分为:前壁MR组与前壁no-MR,下壁MR组与下壁no-MR组4个亚组。观察各组的临床情况与心血管事件。结果:MR组63例,占43.4%,与no-MR组相比,其年龄、左心室射血分数、终点心血管事件及随访期间心血管事件均差异具有统计学意义(P<0.05)。亚组间相比,前壁AMI-MR组与下壁AMI-MR组与相应的no-MR组比较终点心血管事件差异具有统计学意义,且该2组间随访期间临床心血管事件差异具有统计学意义(P<0.05);下壁AMI-MR组与no-MR组2组间的终点心血管事件差异具有统计学意义(P<0.05)。结论:AMI患者伴发MR提示预后不良,AMI患者伴有MR与梗死部位有关,且其部位与预后密切相关。     

Prognosis predictor of chronic-stage acute myocardial infarction

An investigation of acute myocardial infarction (AMI) was performed in Obihiro City, Hokkaido from October 1.1990 to March 31.1996. Based on the recorded cases, we conducted an investigation on the progress of 194 survivors by questionnaires, and we investigated the factors affecting long-term prognosis of AMI. The mean follow-up period was 1.62 years. The mean age at onset and frequency of hypertension were higher in women than in men. On the other hand, a larger percentage of men smoked and drank alcohol. Kaplan-Meier analysis showed that survival was strongly influenced by aging, drinking, prior history of AMI or stroke, renal dysfunction, cardiac failure and early rehabilitation. Using Cox's hazard model, it was found that mortality risk increases 1) by 1.5 times for an increase of 10 years in age (2.6-times higher for people over 65 years old), 2) by 2.5 times for people with a history of AMI or stroke, 3) by 4.6 times for people with renal dysfunction, and 4) by 5.7 times for people with cardiac failure of Killip class III or IV. On the other hand, it was found that mortality risk decreases 1) by 0.3 times for people who drink alcohol, 2) by 0.1 times for people who have undergone PTCA, and 3) by 0.3 times for people who have undergone rehabilitation. The mortality risk is high for people who do not drink alcohol and those who have not undergone rehabilitation using Cox's hazard model adjusted all those factors. In conclusion, prognostic predictor in chronic-stage acute myocardial infarction are aging, drinking, prior history of AMI or stroke, renal dysfunction, cardiac failure, early rehabilitation, and PTCA. The results also indicated that, regardless of the historical and clinical characteristics, early rehabilitation is very important to increase the probability of long-term survival.     

Prognosis following acute myocardial infarction in patients with ST-T abnormalities on electrocardiograms obtained before myocardial infarction

BACKGROUND: Many studies have examined the relationship between prognosis after myocardial infarction (MI) and electrocardiographic (ECG) findings at the time of or after the onset of MI. However, little work has been done concerning the association between ECG findings obtained before the onset of MI (pre-MI) and the prognosis after MI. HYPOTHESIS: The study was undertaken to determine whether ST-T segment and T-wave morphology on pre-MI ECGs provides useful information for prognosis after acute MI. METHODS: Pre-MI ECGs of 212 patients recorded within the 6-month period before MI were studied for the presence of high-voltage R waves, ST-segment depression, and negative T waves. The Kaplan-Meier method and multivariate analysis were used to determine the relationship between these ECG findings and in-hospital cardiac death. RESULTS: In-hospital cardiac death occurred in 32 (15.1%) patients. The in-hospital mortality rate was 38.5% (5/13) for the patients with high-voltage R waves, 54.5% (6/11) for patients with ST-segment depression, and 45.6% (15/33) for patients with negative T waves. The in-hospital mortality rate was 13.6% (27/199) for patients without high-voltage R waves, 12.9% (26/201) for patients without ST-segment depression, and 9.5% (17/179) for those without negative T waves. Multivariate analysis identified age and negative T waves as independent risk factors for cardiac death, with a hazard ratio for negative T waves of 3.1. CONCLUSION: Negative T waves on pre-MI ECGs represent an independent predictor of in-hospital cardiac death in patients with MI.     

Q波型与非Q波型心肌梗死患者的近期预后

为探讨心肌梗死有无Ｑ波对近期预后的影响，随诊７８例无Ｑ波型心肌梗死（ＮＱＭＩ）和２２４例Ｑ波型心肌梗死（ＱＭＩ）患者，随诊以死亡为终点或随诊至患病后６个月。两组相比：１．院内死亡率分别为２．５６％和１３％（Ｐ〈０．０１），２．Ｋａｐｌａｎ－Ｍｅｉｅｒ曲线６个月生存率分别为９４．９％和８１．５％（时距检验Ｐ〈０．０１），６个月无心脏再发缺血事件发生分别为８５．５％和６９．１％（时距检验Ｐ〈０．０１）     

Prognosis of patients with diabetes mellitus after acute myocardial infarction

Sixty patients with diabetes mellitus who survived the coronary care unit phase of acute myocardial infarction (AMI) were followed an average of 19 months and the prognosis of diabetic patients was compared with that of 719 nondiabetic patients. The mortality rate was 25% in diabetic patients and 8% in nondiabetic patients. These patients had been entered in a Multicenter Postinfarction Program, where analysis of the total data base showed 4 significant prognostic factors: cardiac symptoms before AMI, pulmonary rales when the patient was in the coronary care unit, more than 10 ventricular premature complexes per hour recorded on Holter monitor just before discharge, and a radionuclide ejection fraction of less than 40%. Of these 4 factors, only cardiac symptoms before AMI was significantly more common in diabetic patients (57% in diabetic vs 36% in nondiabetic patients). When each of these 4 factors was stratified for severity, the mortality rate was always higher in diabetic patients. The data were examined to determine other factors in diabetic patients who died. Pulmonary rales was significantly more common in diabetic patients who died (6% in survivors vs 42% in patients who died). In a multivariate analysis of both diabetic and nondiabetic patients, 5 factors were significant determinants of prognosis. They are, in order of entry into the model, rales (p less than 0.001), ejection fraction less than 40% (p less than 0.001), diabetes (p less than 0.001), symptoms before AMI (p = 0.009), and more than 10 ventricular premature complexes per hour (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognosis of left anterior hemiblock in acute myocardial infarction

Four of 32 patients with left anterior hemiblock and an acute anterior wall myocardial infarction died. Left anterior hemiblock was present on admission in 24 patients, and subsequently appeared in 8. Of the 28 survivors, 21 are still alive an average of 2.8 years after the acute myocardial infarction.     

Prognosis of the acute stage of myocardial infarction. Rhythm factors

At the present time, it is still difficult to determine the real prognostic significance of cardiac arrhythmias in the acute phase of myocardial infarction. The metabolic and electrogenic consequences of myocardial ischaemia are responsible for the principal mechanisms involved in the development of arrhythmias in the ICU: conduction disorders and/or ventricular arrhythmias. Based on a review of the literature, the author analyses the prognostic value of the principal arrhythmias: branch block, atrio-ventricular block, primary ventricular fibrillation and repetitive or isolated ventricular extrasystoles. A number of conclusions can be drawn from this study: isolated arrhythmias in the acute phase are a sign of metabolic and electrolyte disorders and only influence the immediate prognosis. The same arrhythmias, associated with anatomical damage, altered myocardial function or heart failure, may be the sign of severe, long term complications. The development of arrhythmias in the acute phase of infarction should not be interpreted in isolation, but together with the results of further investigations to test the value of the myocardium and the electrical instability. The patient's real risk can only be evaluated on the basis of all of these findings.     

急性心肌梗塞患者左心室整体形态的预后价值

154例发病72小时内的不伴心源性休克首次心梗患者,在入院3天内用超声心动图测定左心室球形指数(SI)、左室容量和射血分数.平均随访20.7±8.7个月,并观察随访期间心性死亡和心衰.发现部分SI与左室容量和射血分数相关,对观察期内心性死亡有预测价值.长度方面的SI对心胜死亡有独立于左室容量之外的预测价值.     

Prognosis in diabetics with chest pain or other symptoms suggestive of acute myocardial infarction.

We evaluated the prognosis of 599 diabetics who came to the emergency department with chest pain or other symptoms suggestive of acute myocardial infarction (AMI). They made up 8% of the patients with such symptoms (n = 7,157). Diabetics had a 1-year mortality rate of 25% as compared with 10% for nondiabetics (p less than 0.001). The difference remained significant regardless of whether there was a strong or a vague initial suspicion of AMI. On admission, independent risk factors for death were age, acute congestive heart failure and initial degree of suspicion of AMI. We conclude that among diabetics who appear in the emergency department with chest pain or other symptoms suggestive of AMI, 25% are dead within 1 year. The prognosis is directly related to the initial suspicion of AMI.     

Prognosis in acute myocardial infarction in relation to development of Q waves.

In a totally nonselected group of patients with acute myocardial infarction (AMI) (n = 921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non-Q-wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty-two percent had AMI without new Q waves. Patients with a non-Q-wave AMI differed from patients with Q-wave AMI, more frequently having a previous history of AMI (p less than 0.001), angina pectoris (p less than 0.01), diabetes mellitus (p less than 0.05), congestive heart failure (p less than 0.001), and a higher mean age (p less than 0.001), whereas smoking was more common in Q-wave AMI. Patients with non-Q-wave AMI had a 1-year mortality of 31% compared with 26% in Q-wave AMI (p greater than 0.2) and a reinfarction rate of 20% compared with 12% for Q-wave AMI (p less than 0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1-year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non-Q-wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow-up is not associated with development of Q waves.