急性高血糖对老年急性心肌梗死患者预后的影响

目的探讨入院时高血糖对老年急性心肌梗死(AMI)患者住院期间预后的影响。方法不伴糖尿病的老年AMI患者490例,根据入院时血糖水平分为3组,正常组223例,血糖水平<6.1 mmol/L;轻度增高组150例,血糖水平6.1～7.8 mmol/L;高血糖组117例,血糖水平>7.8 mmol/L。对3组患者一般临床资料、主要并发症和病死率进行比较。结果高血糖组女性患者比例较多,与正常组和轻度增高组比较,差异有统计学意义(P<0.05);高血糖组患者肌酸激酶,肌酸激酶同工酶峰值高、血压低、心率快,与正常组和轻度增高组比较,差异有统计学意义(P<0.05);高血糖组患者住院期间病死率19.66%,与正常组和轻度增高组的8.07%、14.67%比较,差异有统计学意义(P<0.05);高血糖组住院期间并发症发生率较正常组和轻度增高组增高(P<0.05)。结论急性高血糖可能是不伴糖尿病的老年AMI患者预后不良的标志之一。     

年龄对急性心肌梗死患者预后影响的分析

目的研究年龄段急性心肌梗死患者预后的影响。方法收集2016年度住院治疗的374例急性心肌梗死患者作为研究对象,根据年龄分为中青年组（<65周岁,110例）和老年组（≥65周岁,264例）,比较两组患者住院期间临床资料和随访1年的病死率、心血管事件发生率。结果老年组患者合并高血压和糖尿病比例、血压和心率均显著高于中青年组急性心肌梗死患者（P<0.05）,成功再灌注患者比例和左室射血分数显著低于中青年组（P<0.05）;老年组患者住院期间病死率、1年随访期间病死率和心血管事件再发生率均显著高于中青年组（P<0.05）;Logisitc回归分析显示,年龄是影响AMI患者病死率（OR=2.241, 95%CI=0.978-3.216, P=0.018）和出院后心血管事件发生率（OR=1.210, 95%CI=1.144-1.278, P=0.027）的独立危险因素。结论年龄是急性心肌梗死患者近期预后的影响因素,年龄越高的AMI患者病死率和心血管事件再发率越高。     

多脏器功能衰竭对急性心肌梗死预后的影响

目的：探讨多脏器功能衰竭对急性心肌梗死的预后及溶栓治疗的影响。方法：326例急性肌梗死病人被分为多脏器功能衰竭组和非脏器功能衰竭组，比较两组的病死率；84例溶栓治疗被分为多脏器功能衰竭组和非多脏器功能衰竭组，比较两组再通率和年龄。结果：急性心肌梗死伴多脏器功能衰竭患病死率明显高于非多脏器功能衰竭（P＜0．01），多脏器功能衰竭使溶栓成功率明显降低（P＜0．01）。结论：积极地预防与治疗多脏器功能衰竭, 可提高溶栓成功率，有效地改善急性心肌梗死病人的预后，降低病死率。     

Long-term prognosis in acute myocardial infarction

The purpose of this communication is to identify the variables contributing to long-term morbidity and mortality in survivors of an acute myocardial infarction (AMI). The study comprises 5 years of follow up in 364 patients who were admitted to the coronary care unit during the acute episode. At the end of the study, 34.5% of the patients had some degree of incapacity due to angina, cardiac failure or both. There was a precise correlation between these and the degree of myocardial dysfunction or the size of the cardiac silhouette during the AMI. Sixty-seven patients suffered a cardiac death. The 5 year cumulative survival rate by life table analysis was 78.6% at the end of the study. The death rate was clearly greater during the initial six months (7%) and reached 10.5% at the end of the first year. In subsequent years the average annual death rate was 2.2%. Two-fifths of the patients died during a recurrent AMI, one-fifth in chronic cardiac failure and the remaining two-fifths experienced a sudden death. Age, a previous infarction, ventricular dysfunction during the acute episode and a recurrent AMI resulted in a reduced possibility of post-hospital survival. Sex of the patients and ECG location of the AMI had no influence in mortality. The analysis of late deaths due to AMI suggests that mechanical dysfunction, residual ischemia and electrical instability are important factors in its determination. The data indicate that there may be considerable potential to reduce the cardiac death rate in the post-hospital phase of AMI.     

血红蛋白水平对急性心肌梗死患者近期预后的影响

目的探讨急性心肌梗死患者入院时血红蛋白水平与30d心性死亡和并发症之间的关系。方法在解放军总医院住院的660例急性心肌梗死患者，依据血红蛋白水平将其分为A（〈100g／L）、B（100～119g／L）、C（120～139g／L）、D（140～159g／L）、E（≥160g／L）5组。分析不同血红蛋白水平对急性心肌梗死30d病死率及并发症的影响并探讨其相关因素。结果30d病死率分别为25．0％，20．4％，10．6％，4．3％和8．5％（P〈0．001）；心力衰竭为36．1％，25．5％，20．9％，8．6％和5．1％（P〈0．001）；肺炎为33．3％，23．5％，8．5％，2．2％和5．1％（P〈0．001）；消化道出血为19．4％，5．1％，0．9％，0．9％和1．7％（P〈0．001）；但是，心源性休克和室速／室颤的发生率5组间差异无统计学意义。偏相关分析显示急性心肌梗死患者的血红蛋白水平与患者年龄呈负相关（P〈0．001）；与血浆白蛋白和载脂蛋白A1正相关（P〈0．001和P=0．001）。结论依据急性心肌梗死患者血红蛋白水平，其近期死亡和（或）严重并发症的发生率呈J型曲线，血红蛋白水平越低，近期死亡和（或）严重并发症的风险越大；较多的老年急性心肌梗死患者血红蛋白水平低于非老年患者。     

糖化血红蛋白对非糖尿病患者急性心肌梗死预后的影响

目的：评估入院糖化血红蛋白（HbAlc）水平对非糖尿病患者急性心肌梗死预后的影响。方法纳入2005年1月~2010年12月在湖北理工学院附属医院急性心肌梗死（AMI）且不合并糖尿病患者420例,所有患者在入院后即刻采血,采用比色法检测血糖（Glu）、高压液相层析法检测HbAlc。将患者根据入院HbAlc水平分为4组：3.5%≤HbAlc＜5.0%（n=122）,5.0%≤HbAlc≤5.5%（n=87）,5.5%≤HbAlc＜6.0%（n=109）和6.0%≤HbAlc＜6.5%（n=102）。主要研究终点为1年全因死亡率,次要终点是30天死亡率和CK-MB峰值。结果入组患者总体1年死亡率为13.57%,其中3.5%≤HbAlc＜5.0%组为8.2%,5.0%≤HbAlc＜5.5%组为11.5%,5.5%≤HbAlc＜6.0%组为13.8%,6.0%≤HbAlc＜6.5%组为21.6%,各组间均有统计学差异;但各组间30 d死亡率和CK-MB峰值无统计学差异（P＞0.05）。Cox回归模型显示HbA1c是1年死亡风险的独立预测因子（OR=1.2,P＜0.05）。结论急性心肌梗死的非糖尿病患者入院时HbA1c水平是患者1年死亡率的预测指标,HbA1c水平越高则患者1年死亡率越高。     

他汀类药物对急性心肌梗死患者应激性高血糖的影响

目的探讨他汀类药物对于急性心肌梗死(AMI)患者应激性高血糖的影响。方法纳入2009年1月至2012年12月间,发生AMI的非糖尿病患者,分别调查血糖、血脂、肝肾功能、合并疾病以及口服药物,分析入院后出现应激性高血糖的相关的危险因素。结果 316例非糖尿病AMI患者符合入选标准,其中男性183例,女性133例,年龄47~89(67±12.8)岁。33.23%(105例)患者发生了应激性高血糖。二分类Logistic回归分析提示年龄(OR=2.992,95%CI:1.045~8.565,P=0.041),以及他汀类药物使用(OR=2.852,95%CI:1.051~7.741,P=0.040)为AMI患者应激性高血糖发生的危险因素。结论他汀类药物的使用促进AMI患者应激性高血糖的发生。     

肾素-血管紧张素-醛固酮系统与急性心肌梗死短期预后关系的研究

目的研究肾素-血管紧张素-醛固酮系统(RAAS)与急性心肌梗死短期预后的相关性。方法纳入2012年6月~2012年12月江西省人民医院急性心肌梗死患者33例(AMI组)及健康体检者30例(对照组),比较两组RAAS系统中血清肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(Ald)的水平差异。3个月后对AMI组患者行彩色超声心动图测定左室功能[包括:左室舒张末径(LVEDD)、左室收缩末径(LEVSD)和射血分数(LVEF)],观察其与RAAS的相关性;同时按照AngⅡ水平将AMI组分为低AngⅡ亚组(AngⅡ≤249.1 pg/ml,n=19)和高AngⅡ亚组(AngⅡ249.1 pg/ml,n=14),观察3个月随访期间两组心血管事件(MACE)的发生情况。结果与健康组相比,AMI组患者PRA[(6.5±2.4)ng/(ml.h)vs.(0.5±0.4)ng/(ml.h)]、AngⅡ[(226.9±66.3)pg/ml vs.(47.4±11.9)pg/ml]、Ald[(401.8±91.2)vs.(294.1±43.4)pg/ml]水平均较高,差异有统计学意义(P0.01);AMI组患者AngⅡ水平与患者3个月后的LVEDD(r=0.788,P0.01)及LEVSD呈正相关(r=0.770,P0.01),与LVEF呈负相关(r=-0.782,P0.01);AMI患者中高AngⅡ亚组3个月内心血管事件发生率显著高于低AngⅡ亚组(100%vs.42.11%,P0.01)。结论心肌梗死患者存在RAAS过度激活,AngⅡ水平与心肌梗死后左室重构、心功能及心血管事件等预后情况明显相关。     

糖化血红蛋白对急性心肌梗死患者预后的影响

目的观察糖化血红蛋白(HbA1c)对急性心肌梗死患者预后的影响。方法选择发病时间12 h、ST段抬高心肌梗死患者541例。根据入院时HbA1c水平分为2组:HbA1 c升高组206例(HbA1c≥6.5%)和对照组335例(HbA1 c6.5%),分析HbA1c水平对患者预后的影响。结果 2组在年龄、吸烟、前壁急性心肌梗死、发病至就诊时间、冠状动脉造影、再灌注成功率、双支血管病变及住院期间药物治疗方面差异无统计学意义(P0.05)。HbA1c升高组患者糖尿病、高血压、血糖水平、3支血管病变、住院期间发生心力衰竭、心源性休克及病死率明显高于对照组;男性比例、LVEF及单支血管病变比例明显低于对照组。多因素分析结果显示,HbA1c升高是影响住院期间发生心力衰竭(OR=1.355,95% CI:0.498～2.788,P=0.039)及病死率(OR=0.872,95% CI:0.421～1.733,P=0.041)的独立危险因素。结论 HbA1c水平升高是住院期间发生心力衰竭及病死率的预测因素,应重视HbA1c对判断急性心肌梗死患者预后的作用,指导患者控制血糖,改善预后。     

Vitamin D and prognosis in acute myocardial infarction

Background

Vitamin D status (VDS) has been linked to mortality and incident acute myocardial infarction (AMI) in healthy cohorts. Associations with recurrent adverse cardiovascular events in those with cardiovascular disease are less clear. Our objective was to assess the prevalence and prognostic impact of VDS on patients presenting with AMI.

Methods

We measured plasma 25-(OH)D₃ and 25-(OH)D₂ using isotope dilution tandem mass spectrometry, in 1259 AMI patients (908 men, mean age 65.7 ± 12.8 years). The primary endpoint was major adverse events (MACE), a composite of death (n = 141), heart failure hospitalisation (n = 111) and recurrent AMI (n = 147) over median follow-up of 550 days (range 131–1095). Secondary endpoints were fatal and non-fatal MACE.

Results

Almost 74% of the patients were vitamin D deficient (< 20 ng/ml 25-(OH)D). Plasma 25-(OH)D existed mainly as 25-(OH)D₃ which varied with month of recruitment. Multivariable survival Cox regression models stratified by recruitment month (adjusted for age, gender, past history of AMI/angina, hypertension, diabetes, hypercholesterolaemia, ECG ST change, Killip class, eGFR, smoking, plasma NTproBNP), showed 25-(OH)D₃ quartile as an independent predictor of MACE(P < 0.001) and non-fatal MACE(P < 0.01), but not death. Using the lowest 25-(OH)D₃ quartile(< 7.3 ng/ml) as reference for MACE prediction, the 2nd, 3rd and 4th quartiles showed significantly lower hazard ratios (HR 0.59(P < 0.002), 0.58(P < 0.001), and 0.59(P < 0.003) respectively). For non-fatal MACE prediction, the 2nd, 3rd and 4th 25-(OH)D₃ quartiles were all significantly different from the lowest reference quartile (HR 0.69(P < 0.05), 0.54(P < 0.003) and 0.59(P < 0.014) respectively).

Conclusions

VDS is prognostic for MACE (predominantly non-fatal MACE) post-AMI, with approximate 40% risk reduction for 25-(OH)D₃ levels above 7.3 ng/ml.     

Measurement of albuminuria during acute myocardial infarction and its relation with prognosis.

In the recently published study by Kragelund et al.,¹ fastinginsulin, blood glucose, HbA1c, and microalbuminuria were measuredin a large sample of non-diabetic patients with acute myocardialinfarction (AMI) between the second and the fifth day afteradmission. All the above markers were     

Predictors and in-hospital prognosis of recurrent acute myocardial infarction

Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction (AMI). Methods A total of 1686 consecutive AMI patients admitted to Peking University People’s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older (69.3 ± 11.5 vs. 64.7 ± 12.8 years, P < 0.001) and had a higher prevalence of diabetes mellitus (DM) (52.2% vs. 35.0%, P < 0.001) compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age (OR = 1.03, 95% CI: 1.02–1.05; P < 0.001), DM (OR = 1.86, 95% CI: 1.37–2.52; P < 0.001) and reperfusion therapy (OR = 0.74; 95% CI: 0.52–0.89; P < 0.001) were independent risk factors for recurrent AMI. Recurrent AMI patients had a higher in-hospital death rate (12.1% vs. 7.8%, P = 0.039) than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AMI was related with a high risk of in-hospital death.     

Effects of atrial fibrillation on prognosis of acute myocardial infarction

Nine hundred and sixty-nine coronary care patients with acute myocardial infarction were followed for one year. Atrial fibrillation was documented in 107 patients. Compared with patients without atrial fibrillation, those with this arrhythmia were older, had clinically more severe infarction, and had a higher frequency of ventricular fibrillation or tachycardia, and right bundle-branch block. They had similar past histories of ischaemic heart disease and coronary risk factors. Patients with atrial fibrillation had a higher total mortality at 3 months and 12 months. The presence of atrial fibrillation was not associated with any significant increase in mortality within any decade of age or within any subgroup of clinical severity of infarction. The frequency of atrial fibrillation was similar in anterior and inferior infarction. Multiple episodes of atrial fibrillation occurred in 52 patients and episodes usually lasted for over 1 hour. In 50% of patients with single episode of atrial fibrillation the initial ventricular rate was greater than 120 beats per minute.     

有氧运动对急性心肌梗死患者预后的改善研究

目的探讨12周及24周的有氧运动对急性心肌梗死患者心功能及氧代谢功能的影响。方法选取50例急性ST段抬高型心肌梗死并行急诊PCI的患者,随机分为有氧运动治疗(运动组)及非运动治疗(对照组)各25例,2组患者给予相同药物治疗,于入院后第8天、第12周及24周检查无氧阈值、峰值氧耗量、以及LVEF、N末端B型钠尿肽前体(NT-proBNP)水平。结果与对照组比较,运动组第12周及24周后无氧阈值[(15.05±5.80)ml/(kg·min)vs(14.78±1.50)ml/(kg·min),(15.94±0.86)ml/(kg·min)vs(14.43±1.82)ml/(kg·min),峰值耗氧量[(22.31±2.50)ml/(kg·min)vs(19.50±2.52)ml/(kg·min),(23.06±2.13)ml/(kg·min)vs(19.79±2.89)ml/(kg·min)],LVEF[(55.8±2.8)%vs(53.3±5.1)%,(56.5±2.9)%vs(53.7±5.2)%]明显升高,而NT-proBNP[(2171.4±1014.0)ng/L vs(2922.8±1342.6)ng/L,(1628.2±740.1)ng/L vs(2476.7±964.8)ng/L]明显降低(P<0.05,P<0.01)。与同组第8天比较,2组12、24周后无氧阈值、峰值氧耗量、LVEF明显升高,而NT-proBNP明显降低(P<0.05,P<0.01),运动组24周较12周时NT-proBNP明显降低(P<0.05)结论有氧运动治疗可以明显改善急性心肌梗死患者的心功能及氧代谢指标。     

Impact of obesity on long-term prognosis following acute myocardial infarction

OBJECTIVE: To evaluate the impact of obesity on mortality in patients with acute myocardial infarction. METHODS: This study comprises 6676 consecutive patients with acute myocardial infarction screened for entry into the Danish Trandolapril Cardiac Evaluation (TRACE) study. At baseline, body mass index (BMI) and waist to hip ratio (WHR) were measured. Survival status was determined after 8-10 years. RESULTS: BMI was used to divide patients into 4 groups: underweight, normal weight, overweight and obese. The normal weight group was used as reference for the other groups. WHR was divided in quartiles and the lowest quartile was used as reference for the three other quartiles. The prevalence of overweight (BMI 25-29.9 kg/m(2)) and obesity (BMI>30 kg/m(2)) were 48% and 13% in males and 31% and 13% in females. Obese patients were younger, less often smokers and more frequently suffered from diabetes and hypertension. In both men and women, there was no association between obesity assessed as BMI and mortality [men: adjusted RR=0.99 (0.85-1.14, p=0.3); women: adjusted RR=0.90 (0.74-1.10, p=0.2)]. Men with WHR in the upper quartile had an increased mortality [adjusted RR=1.21 (1.07-1.37, p<0.01)]. Increasing WHR in women showed a trend of increased mortality, although this was not significant [adjusted RR=1.13 (0.95-1.34, p=0.2)]. CONCLUSION: In patients with acute myocardial infarction overall obesity as assessed by body mass index is inversely related to mortality. However, abdominal obesity appears to be an independent predictor of all-cause mortality in men and perhaps also in women.