INFLUENCE OF LOCATION AND EXTENT OF MYOCARDIAL-INFARCTION ON LONG-TERM VENTRICULAR DYSRHYTHMIA AND MORTALITY
INFLUENCE OF LOCATION AND EXTENT OF MYOCARDIAL-INFARCTION ON LONG-TERM VENTRICULAR DYSRHYTHMIA AND MORTALITY
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DOI：
10.1161/01.cir.60.4.805
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发表时间：
1979-01-01
期刊：
影响因子：
37.8
通讯作者：
SOBEL, BE
中科院分区：
文献类型：
--
作者：
GELTMAN, EM;EHSANI, AA;SOBEL, BE
虽然用酶学方法估计的梗塞范围似乎是梗塞后早期发病率和死亡率的一个重要决定因素，但它对长期存活期和晚期室性心律失常的影响尚不明确。对173名年龄在66岁以下、无心肌梗死病史、急性心肌梗死存活至少24小时的患者进行前瞻性研究。根据2导联24小时动态心电图，用酶标法估计梗塞面积，用计算机量化心律失常。死亡者的平均梗塞面积指数(ISI)显著大于存活者(46.5±-)。5.8(平均标准误差)与21.1.+-.1.4CK[肌酸激酶]-g-eq[当量]/m2，P<；0.001)。小梗死(ISI<；15CK-g-eq/m2)或中度梗死(15.1req/m2)后总体存活率显著提高。ISI<；30)，而不是大面积脑梗塞(ISI。30)(P<；0.01，P<；0.05)。无论梗死部位如何，小梗死灶的患者比大梗死灶的患者预后更好。跨壁心肌梗死和心内膜下心肌梗死的晚期死亡率相似，但前壁心肌梗死的晚期死亡率高于下壁心肌梗死后的死亡率(15%比6%；P<；0.05)。在用多因素分析评估的10个临床和血流动力学变量中，ISI(但不是梗死灶)、峰值血肌酸激酶、入院时充血衰竭、年龄和性别与死亡率显著相关。室性早搏在中度或大面积梗死(ISI)患者中更为常见。15)在整个随访过程中(P<；0.05)，与梗塞部位无关。无论是在急性心肌梗死后的晚期还是早期，心肌梗死的范围都是室性心律失常和死亡率的重要决定因素。
Although the extent of enzymatically estimated infarct size appears to be an important determinant of morbidity and mortality early after infarction, its influences on long-term survival and late ventricular dysrhythmia are not yet characterized. Patients (173) younger than 66 years of age without evidence of prior myocardial infarction, who survived acute myocardial infarction for at least 24 h were studied prospectively. Infarct size was estimated enzymatically and dysrhythmia quantified by computer from 2-channel, 24-h ambulatory ECG. The mean infarct size index (ISI) of those who died was significantly larger than that of survivors (46.5 .+-. 5.8 (SEM [standard error of the mean]) vs. 21.1 .+-. 1.4 CK[creatine kinase]-g-eq[equivalent]/m2, P < 0.001). Overall survival was significantly better after small (ISI < 15 CK-g-eq/m2) or modest infarcts (15 .ltoreq. ISI < 30) than after large infarcts (ISI .gtoreq. 30) (P < 0.01, P < 0.05, respectively). Regardless of the locus of the infarction, patients with small infarcts had a better prognosis than those with larger infarcts. Late mortality was comparable after transmural and subendocardial infarction, but higher after anterior than after inferior infarction (15 vs. 6%; P < 0.05). Of the 10 clinical and hemodynamic variables evaluated with multivariate analysis, ISI (but not infarct locus), peak plasma creatine kinase, congestive failure at the time of admission, age and gender were significantly related to mortality. Premature ventricular complexes were more frequent among patients with modest or large infarcts (ISI .gtoreq. 15) throughout the follow-up (P < 0.05), regardless of infarct locus. The extent of infarction is a strong determinant of both ventricular dysrhythmia and mortality, late as well as early after acute myocardial infarction.