卡托普利早期和长期治疗对老年急性心肌梗死患者生存率的影响

目的　比较早期和长期卡托普利治疗对≥65岁和＜65岁急性心肌梗死(心梗)患者生存率的影响。　方法　根据是否早期及长期卡托普利治疗，将822例首次心梗72h内入院患者分为＜65岁卡托普利组209例、≥65岁卡托普利组269例，＜65岁对照组131例、≥65岁对照组213例。　　结果　住院期(1～42d)＜65岁卡托普利组死亡8例(3.83%)，＜65岁对照组死亡10例(7.63%)，差异无显著性(P＞0.05)；≥65岁卡托普利组死亡25例（9.29%），≥65岁对照组死亡52例（24.41%），差异有显著性(P＜0.0001)。卡托普利治疗患者住院期心原性死亡与年龄相关(P=0.0002)，随访1.3～54.0个月表明，心原性死亡与年龄关系不密切；＜65岁卡托普利组158例中猝死3例(1.9%)，＜65岁对照组97例猝死11例(11.4%，P＜0.01)；≥65岁卡托普利终访192例中猝死7例(3.6%)，≥65岁对照组终访128例中猝死25例(19.5%，P＜0.01)。≥65岁和＜65岁卡托普利组心源性事件发生也低于相应对照组(P＜0.01)。　结论　卡托普利治疗急性心梗作用住院期有年龄差异，而长期应用改善预后作用无年龄差异。

Comparison of the effects of early and long-term captopril treatment on the elderly and younger patients after acute myocardial infarction

Objective To compare the effects of early and long term treatment with captopril on clinical outcome between elder patients (65 75 years old) and younger patients (< 64 years old) suffering from acute myocardial infarction (AMI). Methods In a randomized trial, 822 patients with a first AMI were treated with captopril at initial dosage of 6 25 mg and adjusted to 25 mg t i.d according to blood pressure (209 younger patients, 269 elder patients) and conventional treatment (131 younger patients, 213 elder patients). Survival rate of the four groups was calculated with Kaplan Meier method. Results The survival of treatment group was correlated significantly with age during hospitalization ( P =0 0002). Eight patients in younger treatment group and 10 patients in younger control group (3 83% vs 7 63%, P >0 05), 25 patients in elder treatment group and 52 patients in elder control group (9 29% vs 24 41%, relative risk = 0 37, 95% CI 0 29 0 48, P <0 0001) were died. During follow up period, the survival was however not related to the age ( P >0 05), and both the elder and younger patients had better survival (all P <0 01 ) and lower cardiac events (all P <0 01) during captopril treatment. Conclusions Captopril exerts less effect on the younger patients but more effect on the elder patients during hospitalization after AMI. Long term captopril had no difference between the youngers and the elders in prognosis.