老年心肌梗死伴室壁瘤形成的临床病理特点分析

目的 探讨老年心肌梗死伴与不伴室壁瘤形成的临床病理差异.方法 对107例经尸检证实的老年人(60～90岁)心肌梗死按伴与不伴室壁瘤形成分为室壁瘤组与对照组(室壁瘤组31例,对照组76例)进行临床病理对照分析.结果 室壁瘤组有心绞痛史者占45.2％( 14/31),少于对照组的92.1％(70/76,P=0.047).室壁瘤组合并高血压77.4％( 24/31),多于对照组的36.8％( 28/76,P=0.033).室壁瘤组冠状动脉单支病变占54.8％(17/31),多于对照组的23.7％( 18/76,P=0.033);前降支严重病变(狭窄大于Ⅲ级)占96.8％(30/31),多于对照组的51.3％ (39/76,P=0.048).室壁瘤组的死亡原因以心力衰竭和室性心律失常多见56.3％ (18/31)],室壁瘤形成部位则以前壁及心尖处多见87.1％(27/31)].结论 老年心肌梗死伴室壁瘤形成患者多合并高血压,既往常无心绞痛史,冠状动脉以前降支单支严重病变常见,死亡原因以心力衰竭和室性心律失常多见,室壁瘤部位则多见于前壁及心尖处.

Clinicopathologic analysis of myocardial infarction with or without left ventricular aneurysm formation in the elderly patients

Objective To analyze the clinic-pathologic features of elderly myocardial infarction patients ( ＞ 60 years) with and without left ventricular aneurysm formation.Methods Between January 1980 and October 2009,107 myocardial infarction patients were divided into aneurysm group (n =31 ) and non-aneurysm group ( n = 76) according to autopsy results and the clinic-pathologic features of the two groups were compared.Results Previous angina pectoris history was significantly less in aneurysm group than in non-aneurysm group 45.2％ ( 14/31 ) vs.92.1％ ( 70/76 ),P = 0.047 ].Incidence of hypertension was significantly higher in aneurysm group than in non-aneurysm group 77.4％ (24/31) vs.36.8％ (28/76),P = 0.033 ].The percentage of single-vessel disease 54.8％ ( 17 /31 ) vs.23.7％(18/76),P =0.033] and the LAD disease 96.8％ (30/31) vs.51.3％ (39/76),P =0.048] were both significantly higher in aneurysm group than in non-aneurysm group.Heart failure and ventricular arrhythmias were more likely the cause of death in patients with aneurysm than patients without aneurysm 56.3％ (18/31) vs.19.7％ ( 15/76),P = 0.007 ].Aneurysm mostly located in left ventricular anterior wall and apex.Conclusions Our results suggest that patients with left ventricular aneurysm formation are more likely to have hypertension,single-vessel disease and LAD disease,heart failure and ventricular arrhythmias but less previous angina pectoris than patients without left ventricular aneurysm formation.The common locations of ventricular aneurvsm formation were left ventricular anterior wall and apex.