PREINFARCTION ANGINA AS A MAJOR PREDICTOR OF LEFT-VENTRICULAR FUNCTION AND LONG-TERM PROGNOSIS AFTER A FIRST Q-WAVE MYOCARDIAL-INFARCTION
PREINFARCTION ANGINA AS A MAJOR PREDICTOR OF LEFT-VENTRICULAR FUNCTION AND LONG-TERM PROGNOSIS AFTER A FIRST Q-WAVE MYOCARDIAL-INFARCTION
复制标题
DOI：
10.1016/0735-1097(95)80002-x
复制
发表时间：
1995-08-01
影响因子：
24
通讯作者：
OGAWA, S
中科院分区：
文献类型：
--
作者：
ANZAI, T;YOSHIKAWA, T;OGAWA, S
目标。本研究的目的是评估首次Q波心肌梗死后梗死前心绞痛的预后意义。对前壁心肌梗死和下壁心肌梗死患者进行比较。梗死前心绞痛对前、下段心肌梗死后预后的影响尚不清楚。291例首次Q波前（n = 171）或下（n = 120）心肌梗死患者被检查，以评估梗死前心绞痛对短期和长期预后的影响。我们还探讨了出院前左心室造影与梗死前心绞痛的关系。梗死前心绞痛的存在与较低的峰值肌酸激酶活性、较低的住院持续性室性心动过速和纤颤发生率以及较低的泵衰竭发生率和心脏死亡率有关，无论是前梗死还是下梗死。在前路梗死患者中，梗死前心绞痛与梗死后1年内较低的心脏破裂发生率和较低的心力衰竭再入院率相关。在这个亚组中，它还与较高的射血分数、较小的舒张末期容积和较低的康复期间心室造影显示的动脉瘤形成发生率相关。在下壁梗死患者中，这些变量在是否存在梗死前心绞痛方面没有显著差异。多变量分析证实，梗死前心绞痛的存在是室性动脉瘤发展、晚期心力衰竭和1年心脏死亡率的独立预测因子。梗死前心绞痛的存在对梗死扩张和晚期左心室功能有有利的影响，特别是在前路心肌梗死患者中。造成这种现象的机制尚不清楚，但可能是继发于梗死面积的限制，其机制不明，而不是侧枝作用（例如，缺血预处理）。
Objectives. The purpose of this study was to assess the prognostic significance of preinfarction angina after a first Q wave myocardial infarction. Patients with anterior or inferior myocardial infarction were compared.Background. The effect of preinfarction angina on prognosis after anterior and inferior myocardial infarction remains unclear.Methods. A total of 291 patients,vith a first Q wave anterior (n = 171) or inferior (n = 120) myocardial infarction were examined to assess the effect of preinfarction angina on short- and long term prognosis. The relation between predischarge left ventriculographic findings and preinfarction angina was also examined.Results. The presence of preinfarction angina was associated with lower peak creatine kinase activity, a lower in-hospital incidence of sustained ventricular tachycardia and fibrillation and a lower incidence of pump failure and cardiac mortality in patients with either anterior or inferior infarction. Among patients with anterior infarction, preinfarction angina was associated with a lower incidence of cardiac rupture and less need for readmission for heart failure, within 1 year after the onset of infarction. In this subgroup it was also associated with a higher ejection fraction, a smaller end-diastolic volume and a lower incidence of aneurysm formation noted on ventriculography during convalescence. In patients with inferior infarction, these variables did not differ significantly in the presence or absence of preinfarction angina. Multivariate analysis confirmed that the presence of preinfarction angina was an independent predictor of development of ventricular aneurysm, late phase heart failure and 1-year cardiac mortality.Conclusions. The presence of preinfarction angina has a favorable effect on infarct expansion and late phase left ventricular function, especially in patients with anterior myocardial infarction. The mechanisms responsible for this phenomenon are not known but may be secondary to limitations of infarct size through unidentified mechanisms other than collateralization (e.g., ischemic preconditioning).