不同年龄急性心肌梗死患者心脏超声的临床研究

目的评价不同年龄急性心肌梗死(AMI)患者的心脏超声及冠状动脉造影等临床特征。方法选择AMI患者325例,根据年龄分为<70岁组63例、70～79岁组140例和≥80岁组122例。对各组患者的心脏超声及冠状动脉造影等临床资料进行比较。结果与<70岁组比较,70～79岁组和≥80岁组患者心力衰竭、左心房内径≥39 mm、左心室内径≥50 mm、LVFF<50%、冠状动脉狭窄≥70%、再发心肌梗死死亡、心源性死亡的比例明显升高(P<0.05,P<0.01)。结论对年龄≥70岁AMI患者进行心脏超声检测,积极加强对危险因素干预,对预防再发心肌梗死,并减少心力衰竭、心房颤动、死亡及改善预后有重要临床意义。     

年龄对接受急诊冠状动脉介入术治疗急性ST段抬高心肌梗死患者预后的影响

目的评价年龄对接受急诊冠状动脉介入治疗(PCI)老年急性ST段抬高心肌梗死患者临床预后的影响。方法 221例接受了急诊直接PCI治疗急性ST段抬高心肌梗死患者纳入本研究,根据年龄分为3组:65岁组(107例)、65～74岁组(74例)和≥75岁组(40例),收集基线资料包括年龄、性别、胸痛时间、心肌梗死部位、术前Killip分级、梗死相关血管、冠脉病变血管支数、支架类型、出院前左心室射血分数(LVEF)、心肌酶峰值、血红蛋白、血肌酐、血糖、冠心病危险因素(吸烟、肥胖、高血压、糖尿病和高血脂),临床随访平均(16.7±11.3)个月(6～38个月),主要不良心脏事件(MACE)发生36例。结果多因素Logistic回归分析显示,出院前LVEF是随访期总MACE发生的独立预测因素(P=0.0057)。在65～74岁组和≥75岁组中单支血管病变所占比例明显低于65岁组(P=0.0001);而在65～74岁组和≥75岁组中其双支病变、三支病变所占比例高于65岁组(P=0.0618,P=0.0340)。在65～74岁组和≥75岁组中Killip分级(Ⅱ、Ⅲ、Ⅳ级)的比例明显高于65岁组(P=0.0052);而在65～74岁组和≥75岁组中LVEF明显低于65岁组(P=0.0493);在65～74岁组和≥75岁组中高血压的比例明显高于65岁组(P=0.0162)。随着年龄增长,随访期间MACE发生率明显增高,在65岁组为10.28%、65～74岁组为16.22%、≥75岁组为32.50%(P=0.0051),差异有统计学意义。结论在接受急诊冠状动脉介入治疗的老年急性ST段抬高心肌梗死患者,MACE发生率随年龄增长而增高,年龄、多支血管病变、Killip分级和LVEF可能影响其预后。     

冠状动脉造影影像正常的急性心肌梗死

目的探讨冠状动脉造影影像正常的急性心肌梗死病例的临床特点。方法在349例诊断急性心肌梗死患者行选择性冠状动脉造影检查,其中有17例冠状动脉影像正常,分析这17例患者的性别、年龄、临床症状及预后。结果冠状动脉影像正常的急性心肌梗死占17/349(4.87%),平均年龄(43.6±6.32)岁,45岁以下者15例,全部为男性,临床无心衰、休克及严重心律失常等并发症,预后好。结论急性心肌梗死可以发生在正常的冠状动脉基础上,此种情况多发生在45岁以下的男性患者,病前多健康,临床无严重并发症,预后好,预防冠状动脉痉挛是该病的主要策略。     

冠状动脉造影影像正常的急性心肌梗死病例分析

目的　探讨冠状动脉造影影像正常的急性心肌梗死病例的临床特点。方法　在 34 9例诊断急性心肌梗死患者行选择性冠状动脉造影检查 ,其中有 17例冠状动脉影像正常 ,分析这 17例患者的性别、年龄、临床症状及预后。结果　冠状动脉影像正常的急性心肌梗死占 17/34 9(4 87% ) ,平均年龄 (4 3 6± 6 32 )岁 ,45岁以下者 15例 ,全部为男性 ,临床无心衰、休克及严重心律失常等并发症 ,预后好。结论　急性心肌梗死可以发生在正常的冠状动脉基础上 ,此种情况多发生在 45岁以下的男性患者 ,病前多健康 ,临床无严重并发症 ,预后好 ,预防冠状动脉痉挛是该病的主要策略     

介入治疗对高龄急性心肌梗死患者临床预后的影响

目的　观察直接经皮冠状动脉内介入 (PCI)对高龄ST段抬高的急性心肌梗死 (STEMI)患者临床预后的影响。方法　STEMI连续行直接PCI的患者 1 56例 ,对IRA行直接PCI。随访 1～ 1 2个月患者主要心血管事件 (MACE)的发生率。结果　≥ 75岁组较 <75岁组中脑卒中比例较高 (P <0 0 5) ,患者发病至再灌注时间延长 (P <0 0 5) ,左室射血分数 (LVEF)降低 (P <0 0 5)。共随访 1 4 5例患者 ,两组住院期发生非致命性再次心肌梗死差异无显著性 ,但≥ 75岁组心脏性死亡增高 (9 4%比1 8% ,P <0 0 5) ;随访平均 (7 3± 3 2 )个月 ,≥ 75岁组患者总心脏性病死率明显高于 <75岁组(1 2 5 %比 1 8% ,P <0 0 5)。多变量logistic回归分析提示年龄≥ 75岁与LVEF值降低分别与STEMI患者行直接PCI后心脏性死亡增加密切相关 ,是心脏性死亡事件危险增高的独立预测变量。结论　年龄≥ 75岁因素可能是STEMI患者行直接PCI后心脏性死亡增加的独立预测因子     

75岁以上老年急性心肌梗死患者急诊介入术中发生室性心律失常电风暴的危险因素

目的探讨老年急性ST段抬高型心肌梗死(STEMI)患者行急诊PCI术中发生室性心律失常电风暴(VSA)的危险因素。方法收集急性STEMI且行急诊PCI术的老年患者142例,根据VSA发生情况分为VSA组28例,非VSA组114例,另根据治疗时间不同分为干预组80例,未干预组62例。未干预组年龄≥75岁12例,60~75岁50例;干预组年龄≥75岁29例,60~75岁51例。比较各组发生VSA的危险因素。结果未干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(41.7%vs 32.0%,P0.05)。干预组年龄≥75岁患者VSA发生率明显高于60~75岁患者(13.8%vs 5.9%,P0.05)。干预组年龄≥75岁患者VSA发生率明显低于未干预组年龄≥75岁患者,差异有统计学意义(P0.05)。年龄≥75岁VSA患者心电图J波、QRS波、右冠状动脉、心动过缓、持续低血压以及TIMI 0级比例明显高于非VSA患者(P0.05,P0.01)。多元logisict回归分析显示,心电图J波、心肌肌钙蛋白Ⅰ、TIMI血流分级、持续低血压是年龄≥75岁患者发生VSA的独立危险因素(P0.05,P0.01)。结论提前干预老年急性STEMI患者高危因素,可降低VSA发生率,提高VSA治疗成功率,改善预后。     

急性心肌梗死早期补镁对心律失常的影响

心律失常是急性心肌梗死最为常见的并发症,大约75%～95%急性心肌梗死(AMI)患者发生心律失常,部分可发生心源性猝死。本文探讨AMI早期补镁减少严重心律失常发生的疗效,结果报道如下。1资料与方法1.1一般资料将我院2003年来12h内的初发急性心肌梗死98例住院患者作为研究对象,随机分为镁剂治疗组(A组)52例,其中男34例,女18例,年龄45～72岁,平均(61.0±4.8)岁,急性侧壁心肌梗死16例,急性前壁心肌梗死36例。对照组(B组)46例,其中男30例,女16例,年龄48～68岁,平均(60.0±3.2)岁,急性侧壁心肌梗死14例,急性前壁心肌梗死32例。两组性别、年龄、…     

直接经皮冠状动脉介入治疗在老年急性心肌梗死中的应用

目的评估急诊直接PCI在老年急性心肌梗死患者中应用的可行性、安全性及有效性。方法选择2015年1月~2016年12月在我院心内科住院的急性心肌梗死患者364例,其中≥75岁组90例,75岁组274例。主要观察指标:手术成功率、围术期相关并发症及住院期间死亡和主要不良心血管事件(MACE)发生率。结果≥75岁组手术成功率94.4%,术后TIMI 3级血流达标率87.8%,围术期手术相关并发症9例(10.0%)。≥75岁组住院期间病死率和MACE发生率明显高于75岁组(12.2%vs 2.9%,P=0.001;16.7%vs 5.1%,P=0.000)。结论对于年龄≥75岁的急性心肌梗死患者,经桡动脉急诊直接PCI是一种安全、可行、有效的治疗方案。     

不同年龄段急性心肌梗死病人临床特点分析

目的探讨不同年龄段急性心肌梗死病人的临床特点。方法入选2014年6月至2017年5月期间在西安医学院第二附属医院住院治疗的急性心肌梗死病人,共960例。根据年龄将病人分为4组:55岁组(264例)、55~64岁组(300例)、65~74岁组(256例)、≥75岁组(140例)。查阅病历收集病人的临床资料,比较各组病人之间临床特点的差异。结果 (1)随着年龄的增加,女性急性心肌梗死病人的比例增加,而ST段抬高型心肌梗死的比例下降,不同年龄组之间差异均有统计学意义(P0.05)。在冠心病传统危险因素方面,有吸烟史、血脂异常史和早发冠心病家族史病人的比例随着年龄增加而下降,合并高血压的比例随年龄增加而增加,各组之间差异均有统计学意义(P0.05)。(2)急性心肌梗死病人的主要临床表现是持续性胸痛和大汗,分别占65.9%和64%。随着年龄的增加,持续前胸剧痛、大汗和放射痛的比例减低,各组之间的差异均有统计学意义(P0.05)。结论随着年龄增加,急性心肌梗死发病的性别差异逐渐缩小,近半数≥75岁急性心肌梗死病人为女性。老年心肌梗死病人症状不典型,近半数≥75岁急性心肌梗死病人无持续性胸痛和大汗的典型症状。     

老年冠心病患者非心脏手术麻醉管理

<正> 本研究回顾性总结我院年龄≥75岁的冠心病患者行非心脏手术的麻醉管理经验,现报道如下。 1 资料与方法选择2007年1～12月在北京安贞医院行非心脏手术麻醉的年龄≥75岁的冠心病患者44例,男26例,女18例,年龄75～101(77.5±6.3)岁。高血压32例,糖尿病17例,心肌梗死后<6个月2例,冠状动脉支架置入10例。超声心动图显示左心室舒张功能减退31例,老年性二尖瓣和主动脉瓣钙化致轻中度瓣膜反流,其中LVEF<40%3例,左心室下壁、前壁运动减弱4例,室壁瘤形成2例。ECG显示心     

Neoadjuvant chemoradiotherapy followed by esophagectomy does not increase morbidity in patients over 70

Esophagectomy in elderly esophageal carcinoma patients is correlated with a high morbidity and even mortality. Studies on neoadjuvant chemoradiotherapy (NT) in elderly patients are scarce. The aim of this study was to evaluate the effect of advanced age in combination with NT in esophageal carcinoma patients who underwent an esophagectomy. Patients who underwent NT prior to esophagectomy between 1993 and 2010 were divided into three groups: <70, 70–74, and ≥75 years. Toxicity of NT and postoperative morbidity were compared between groups. Primary endpoints were toxicity, complication rate, and survival. Two hundred thirteen patients underwent NT during the study period, 26 were aged 70–74 years, and 17 were ≥70 years. Toxicity of NT was comparable for younger and elderly patients (46% vs. 54% vs. 47%, P = 0.263). Overall complications occurred in 62% of younger patients versus 73% and 71% among patients aged 70–74 years and ≥75 years, respectively (P = 0.836). Cardiac complications occurred in 14% of younger patients versus 27% and 41% of elderly patients (P = 0.021). Three‐year survival rates were 59% versus 44% versus 31% among patients aged <70, 70–74, and ≥75 years, respectively (P = 0.237). Higher age (odds ratio 1.750, P < 0.001) was an independent risk factor for development of cardiac complications. Toxicity of NT and postoperative complications are comparable for patients aged <70, 70–74, and ≥75 years, with the exception of cardiac complications. Therefore, we consider NT followed by esophagectomy in elderly patients a safe treatment modality in our center.     

Impact of diabetes and gender on survival after acute myocardial infarction in the Province of Quebec,Canada—a population‐based study

Aims To examine the impact of diabetes, gender and their interaction on 30‐day, 1‐year and 5‐year post‐acute myocardial infarction (AMI) mortality in three age groups (20–64, 65–74 and ≥ 75 years). Methods Retrospective analysis including 23 700 patients aged ≥ 20 years (22% with diabetes) admitted to hospital for a first AMI in any hospital in the Province of Quebec, Canada, between April 1995 and March 1997. Administrative databases were used to identify patients and assess outcomes. Results Regarding 30‐day mortality, there was non‐significant interaction between diabetes and gender. Women aged < 75 years had, independently of diabetes status, at least a 38% (P < 0.05) higher mortality than their male counterparts after adjustment for socio‐economic status and co‐morbid conditions. Gender difference disappeared, however, after controlling for in‐hospital complications. Regarding 1‐year mortality (31–365 days), there was no significant gender disparity for all age groups. During the 5‐year follow‐up, no gender differences were seen in any age group, except for younger (< 65 years) women with diabetes, who had a 52% (P = 0.004) higher mortality than men after controlling for co‐variables. This female disadvantage was demonstrated by a significant interaction between diabetes and gender in patients aged < 65 years (P = 0.009). Conclusions The higher 30‐day mortality post‐AMI in younger (20–64 years) and middle‐aged (65–74 years) women compared with men was not influenced by diabetes status. However, during the 5‐year follow‐up, the similar gender mortality observed in patients without diabetes seemed to disappear in younger patients with diabetes, which may be explained by the deleterious, long‐term, post‐AMI impact of diabetes in younger women.     

Cardiogenic shock complicating acute myocardial infarction in the elderly: predictors of long-term survival

Background: Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI), associated with a high mortality. A significant improvement in survival has been reported with immediate coronary revascularization. However, there is no clear evidence of such an improvement amongst older patients. The aim of our work was to evaluate in‐hospital and long‐term outcomes in the group of elderly AMI patients with CS (≥75 years old). Methods: We collected data of 157 consecutive AMI patients with CS who underwent percutaneous coronary intervention (PCI) and compared clinical and procedural characteristics and in‐hospital and long‐term outcomes between patients <75 years and patients ≥75 years old. Results: There were 58 patients (36.9%) with age ≥75 years and 99 patients (63.1%) with age <75 years. Patients were followed up for an average period of 34 months (range 5–69). In‐hospital and long‐term mortality was significantly higher in the older group (55 vs. 25%, P < 0.0001; and 62.1 vs. 37.3%, P = 0.005, respectively). Multivariate predictors of in‐hospital mortality were age ≥75 years (hazard ratio 1.81, 95% CI 1.006–3.27, P = 0.04) and PCI failure (hazard ratio 2.67, 95% CI 1.34–5.307, P = 0.005), whereas, the only multivariate predictor of long‐term mortality was PCI failure (hazard ratio 2.88, 95% CI 1.52–5.46, P = 0.001). Age ≥75 years showed only a trend toward statistical significance (hazard ratio 1.62, 95% CI 0.96–2.76, P = 0.07). Conclusions: In elderly AMI patients with CS, PCI can be performed with an acceptable risk that seems lower than that reported in most previous studies. © 2010 Wiley‐Liss, Inc.     

急性心肌梗死合并心源性休克患者冠脉病变特点及再灌注疗法的效果

目的　探讨急性心肌梗死 (AMI)合并心源性休克患者的冠脉病变特点及再灌注疗法的效果。方法　以74例AMI患者为对象 ,按是否合并心源性休克分为休克组 16例 ,非休克组 5 8例 ,对比两组患者的临床资料 ,冠脉造影及再灌注疗法对预后的影响。结果　休克组院内病死率显著高于非休克组 (P <0 0 5 ) ;休克组各种并发症比例均显著高于非休克组 ,其中梗死延展休克组发生率为 38% ,非休克组为 5 % (P <0 0 1) ;冠脉造影显示 ,休克组 3支病变显著高于非休克组 (P <0 0 1) ,前者 99%以上的严重狭窄病变多、钙化严重及侧支循环发育不良。再灌注治疗后 ,梗死相关冠脉再通率休克组显著低于非休克组 (P <0 0 5 ) ,休克组院内病死率受梗死相关冠脉再通与否的影响 ,再通的 6例仅 1例死亡 ,而未再通的 5例 3例死亡。结论　AMI合并心源性休克患者 ,冠脉病变严重、复杂 ,病死率高 ,改善预后的关键是恢复再灌注及预防梗死延展。     

静息心率与急性心肌梗死关系的临床探讨

目的探讨静息心率(RHR)在急性心肌梗死(AMI)中的变化及临床意义。方法选择住院确诊的AMI患者110例进行RHR测定,以40例体检无异常发现者作为对照,分析RHR与AMI的梗死面积、并发症及预后之间的关系。结果AMI组RHR显著高于正常人(82.8±12.4次/分vs71.8±10.4次/分,P<0.001);不同梗死面积的患者间RHR差异显著(F=6.393,P<0.01),RHR随梗死面积的增加而增快;合并心力衰竭或休克的AMI患者RHR显著高于无合并症者(P<0.05或0.001);RHR增快(≥80次/分)的AMI患者射血分数低于RHR正常(<80次/分)者(P<0.01);住院期间死亡患者RHR亦显著高于病情好转及治愈者(t=3.995,P<0.001),其中RHR≥90次/分的AMI患者的住院病死率显著高于RHR<90次/分的AMI患者(χ2=25.521,P<0.005)。结论RHR与AMI的发生与发展有一定关系,可作为评估AMI病情和预后的指标之一。     

老年急性心肌梗死患者急诊介入治疗的近期疗效分析

目的探讨急诊PCI对老年急性心肌梗死(acute myocardial infarction,AMI)患者的疗效和安全性。方法选择接受急诊PCI的AMI患者351例,分为老年组273例,高龄组78例。比较2组的临床资料、冠状动脉病变特征、住院时间和并发症的发生率。结果老年组单支病变明显高于高龄组,双支、3支病变及合并左主干病变明显低于高龄组(P<0.05,P<0.01)。高龄组置入2个以上支架数、住院期间择期再次PCI、梗死后心绞痛、严重心律失常和≥KillipⅢ级心功能发生率明显高于老年组(P<0.05,P<0.01);2组住院时间、入院到球囊扩张时间、住院期间再梗死、心源性休克发生率和30 d病死率比较,差异无统计学意义(P>0.05)。结论高龄AMI患者行急诊PCI治疗是安全有效的。     

扬州地区行急诊PCI的老年急性心肌梗死患者的临床特点及其预后观察

目的回顾性分析2016年1月至2019年1月入住我院65岁及以上老年急性心肌梗死(AMI)患者的临床特征,并观察急诊经皮冠状动脉介入治疗(PCI)的近期疗效。方法采用回顾性分析的方法,因AMI入住我院患者643例;其中226例行急诊PCI纳入该研究,根据年龄分为≥65岁组(113例)和<65岁组(113例),心电图提示均有不同程度的ST段抬高改变;比较两组患者危险因素、冠状动脉(冠脉)造影、并发症等特点,并对患者出院后进行6个月短期随访,统计分析发生再次因心脏事件住院及发生心源性死亡比例。结果与<65岁组相比,≥65岁组女性、高血压病患者比例均升高,而吸烟比例较低,差异有统计学意义(P<0.05),PCI延误率有差异,但无统计学意义(P>0.05);与<65岁患者相比,>65岁组下壁心肌梗死发生率高,差异有统计学意义(P<0.05),住院期间发生Killip Ⅲ级以上心力衰竭(5.31%vs.3.53%)、严重心律失常(1.76%vs.3.53%)、心源性休克(0.88%vs.2.65%)、死亡(0.88%vs.1.76%)及肺部感染并发症(0.88%vs.2.65%)比例略有升高,差异无统计学意义(P均>0.05);PCI成功率,术后6个月两组患者因心肌梗死或心力衰竭再住院率及死亡率无明显差异(P均>0.05);结论与小于65岁患者相比,大于65岁以上患者其临床特征存在差异,但介入成功率无显著差异,急诊PCI后6个月内再次因心衰、心肌梗死住院及心源性死亡比例无显著差异,充分证明了具有很好的安全性和近期预后,对指导临床治疗有一定意义。     

青年急性心肌梗死的临床特点——附107例分析与研究

目的观察青年急性心肌梗死的临床特点,并探讨其病因。方法对107例45岁以下急性心肌梗死患者及92例中老年患者进行对比,从冠状动脉造影,心功能情况,危险因素三方面进行回顾性综合分析。结果青年急性心肌梗死以男性为主,具有临床表现典型,血管病变简单(冠状动脉造影86例,其中冠状动脉痉挛4例,其余均有冠脉血管病变),死亡率低,预后相对良好等特点。本组有94例(87.9%)有明确冠心病危险因素。结论吸烟、饮酒是青年人急性心肌梗死的最主要诱因,冠脉血管以单支病变为主,发生心功能不全较少,及时予以再灌注治疗对降低死亡率和改善预后十分重要。     

Effect on short- and long-term major adverse cardiac events of statin treatment in patients with acute myocardial infarction and renal dysfunction

The 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) reduce major adverse cardiac events (MACE) and mortality in patients with acute coronary syndrome. We investigated the effectiveness of statin therapy in reducing MACE in patients with acute myocardial infarction (AMI) and renal dysfunction (RD). In the present retrospective study of 12,853 patients with AMI, the patients were categorized into 4 groups: group I, statin therapy and no RD (estimated glomerular filtration rate ≥60 ml/min/1.73 m(2)); group II, neither statin therapy nor RD; group III, statin therapy and RD; group IV, no statin therapy but RD. The primary end points were death and complications during the hospital course. The secondary end points were MACE during 1 year of follow-up after AMI. Significant differences in the composite MACE during 12 months of follow-up were observed among the 4 groups (group I, 11.7%; group II, 19.0%; group III, 26.7%; and group IV, 45.5%; p <0.001). In a Cox proportional hazards model, mortality at 12 months increased stepwise from group II to IV compared to group I. Moreover, MACE-free survival in the severe RD group (estimated glomerular filtration rate <30 mL/min/1.73 m(2)) was also greater in the statin-treated group. In conclusion, statin therapy reduced MACE at 1 year of follow-up in patients with AMI regardless of RD.     

Impact of age on treatment and outcomes after acute myocardial infarction, particularly in very elderly patients

IntroductionThe elderly population admitted for acute myocardial infarction is increasing. This group is not well studied in international trials and is probably treated with a more conservative approach.ObjectivesTo evaluate the presentation and treatment of myocardial infarction according to age, particularly in very elderly patients.MethodsWe studied 1242 consecutive patients admitted with acute myocardial infarction, assessing in-hospital, 30-day and one-year mortality during follow-up for each age-group. Patients were divided into four groups according to age: <45 years (7.6%); 45-64 years (43.3%); 65-74 years (23.4%); and ≥75 years (25.7%).ResultsElderly patients had a worse risk profile (except for smoking), more previous history of coronary disease and a worse profile on admission, with the exception of lipid profile, which was more favorable. With regard to treatment of the elderly, although less optimized than in other age-groups, it was significantly better compared to other registries, including for percutaneous coronary angioplasty. Both complications and mortality were worse in the older groups. In elderly patients (≥75 years), adjusted risk of mortality was 4.9-6.3 times higher (p < 0.001) than patients in the reference age-group (45-64 years). In these patients, the independent predictors of death were left ventricular function and renal function, use of beta-blockers being a predictor of survival.ConclusionsElderly patients represent a substantial proportion of the population admitted with myocardial infarction, and receive less evidenced-based therapy. Age is an independent predictor of short- and medium-term mortality.