天津医药

• 心血管疾病论坛 •    

再发心肌梗死临床特点及其对一年预后的影响

王林1,孙根义1,Seung-Woon Rha2   

  1. 1. 天津市胸科医院
    2. 韩国高丽大学医学中心九老医院
  • 收稿日期:2011-09-21 修回日期:2011-11-30 出版日期:2012-03-15 发布日期:2012-03-15
  • 通讯作者: 王林

The Characteristics and Influences of Recurrent Acute Myocardial Infarction on 1 Year Outcomes

  • Received:2011-09-21 Revised:2011-11-30 Published:2012-03-15 Online:2012-03-15
  • Contact: Lin WANG

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摘要： 摘要 目的: 探讨再发心肌梗死患者的临床特点及其对患者1年内临床预后的影响。方法: 从2005年5月至2008年4月期间，韩国急性心肌梗死注册(KAMIR)研究中入选10384例急性心肌梗死（MI）患者，根据病史分为两组：初次MI组（N=9450）和再发MI组（N=934）。记录年龄、性别、心血管疾病危险因素（高血压、糖尿病、血脂异常、吸烟、家族史等）、合并症、入院时生命体征、体重指数（BMI）、心功能（KILLIP’s分级）、血常规、血脂、心肌酶、肾功能等化验室检查，心脏超声检查记录左室射血分数（LVEF,%）；基础用药及入院后治疗情况。记录患者通过门诊或电话随访的术后12个月时心血管不良事件（MACE）的发生情况。结果: 再发MI患者年龄偏大（63.91±12.48岁 vs 62.54±12.56岁，p<0.05），男性所占比例较高（75.48% vs 71.21%，p<0.05），具备心血管疾病危险因素者所占比例高（p<0.05），同时合并外周动脉疾病（2.57% vs 0.89%，p<0.05）和脑血管疾病（12.74% vs 5.95%，p<0.05）者居多。患者入院时心功能较差（LVEF：47.19%±11.67% vs 51.21%±10.74%，KILLIP’s III-IV级比例: 17.77% vs 10.28%，p<0.05）。再发MI患者1年内总体心血管不良事件发生率明显高于初次MI患者（12.63% vs 8.78%，p<0.05），全因死亡和心源性死亡比率均高于初次MI组（p<0.05）。应用COX回归分析可见，与初次MI相比，再发MI者发生MACE的相对风险率（OR值）为1.481(95% CI:1.222-1.796，P<0.05)，经年龄、性别、KILLIP’s分级、糖尿病、PCI成功等因素校正后，相对风险率（OR值）为1.409(95% CI:1.114-1.782，P<0.05)。结论:再发MI患者基础病情更加严重，且不容易得到充分再血管化治疗，1年内总体MACE发生率明显高于初次梗死患者，是一项独立危险因素。对于MI后患者的二级预防工作更显重要，需要要进一步加强。

关键词: 急性心肌梗死, 再血管化治疗, 经皮冠状动脉介入治疗, 预后, 再发急性心肌梗死

Abstract: Abstract Objectives：To investigate the characteristics of recrurrent myocardial infarction(MI) and the influences of prior MI on the outcomes of patients with myocardial reinfarction(Re-MI). Method: The current data came from the Korea Acute Myocardial Infarction Registry (KAMIR) study, which consisted of consecutive acute MI patients survived from 10 major PCI centers in Korea from November 2005 to April 2008. 10,384 patients survived from hospitals were enrolled, among which 934 (8.99%) patients presented with Re-MI. We investigated the clinical outcomes between Re-MI patients and those with first-onset of MI (first-AMI group, n=9450) within 12-month followup.Results: The baseline characteristics are largely unfavorable in Re-MI group over first-AMI group. Patients in Re-MI group are older than those in first-AMI group (63.91±12.48 vs 62.54±12.56 years，p<0.05) with worse cardiac function(KillipIII/IV, 17.77% vs 10.28%，p<0.05), more prior revascularization history(p<0.001). Angiographic findings also demonstrate unfavorable characters in Re-MI group, such as more multivessle disease(p<0.001), less successful PCI results(p<0.001),et al. Patients with prior MI have worse clinical outcomes than first-AMI group in 12-month mace(ORunadjusted:1.481, 95% CI: 1.222-1.796, P<0.001) even after adjusted by age, killip’s grade, treatment et al(ORadjusted:1.409, 95% CI: 1.114-1.782, P<0.01).Conclusion: Patients with recurrent MI presented with worse baseline characteristics and more severe coronary artery conditions, which might lead to insufficient revascularization and relate to a higher risk of MACE on 1year followup.

Key words: Acute myocardial infarction, Revascularization, Percutaneous coronary intervention, Prognosis, Recurrent myocardial infarction