无心绞痛病史心肌梗塞患者的临床特征及预后

目的：探讨无心绞痛病史的心肌梗塞患者的临床特征及预后。方法：对１１８例无心绞痛病史的心肌梗塞患者（Ａ组）与同期２９３例心肌梗塞前反复出现心绞痛患者（Ｂ组）的临床及随诊资料作对比分析。结果：Ａ组５５．９３％患者诱因明显，多数患者发病年龄较轻，老年患者占１６．１０％，梗塞范围较大；Ｂ组有明显诱因患者仅占２９．３５％，老年患者占３７．２０％，两组比较均有非常显著性差异（Ｐ均＜０．０１）。此外在急性心肌梗塞和随诊期间Ａ组并发症多，病死率高，为９．３２％；Ｂ组病死率为４．１０％，两组比较有显著性差异（Ｐ＜０．０５）。在随诊的３８４例中，Ａ组病死率，尤其是１年内的病死率较Ｂ组为高，且室壁瘤、心力衰竭、各种心律失常的发生率也均明显高于Ｂ组。结论：无心绞痛病史心肌梗塞患者心肌梗塞期间和远期预后不良，但若能在加强常规药物治疗的同时，尽早溶栓治疗并及时进行冠状动脉造影选择冠状动脉内球囊扩张术或冠状动脉旁路手术，可使相当部分患者预后得到改善。

Clinical features and prognosis of patients of myo cardial infarction without the history of angina/

Objective:To investigate the clinical features and prognosis of patients with myocardial infarction without history of angina.Methods:It was made to compare the data of 118 cases of myocardial infarction without history of angina (group A) and 293 cases of reoccured angina prior to myocardial infarction (group B) at the same period.Results:Our data showed that in group A 55 93% patients had notable predisposing factors with relative larger infarct size,most of them were the younger and 16 10% was the elder.However,in group B only 29 35% had notable predisposing factors,elder patients were 37 20%,and significant differences were found between group A and B( P <0 01).In addition,in group A the complications were frequently presented and mortality was 9 32%,being higher than 4 10% by group B during acute myocardial infarction and followingup observation.( P <0 05).Among 384 cases of followingup observation,the mortality especially within one year,was higher in group A than that in group B.Furthermore,the incidences of left ventricular aneurysm heart failure and different kind of arrhythmias in group A were higher obviously than that in group B.Conclusions:The prognosis of these patients during myocardial infarction and longterm observation was poor,but part of patient's prognosis may be improved if patients would be given thrombolytic therapy earlier,and made coronary angiograph selected percutaneous transluminal coronary angioplasty(PTCA),or coronary artery bypass grafting in addition to the routine drug therapy.