LONG-TERM PROGNOSIS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH PREVIOUS CORONARY-ARTERY BYPASS-SURGERY
LONG-TERM PROGNOSIS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH PREVIOUS CORONARY-ARTERY BYPASS-SURGERY
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DOI：
10.1016/0735-1097(88)90447-0
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发表时间：
1988-10-01
影响因子：
24
通讯作者：
THEROUX, P
中科院分区：
文献类型：
--
作者：
WISEMAN, A;WATERS, DD;THEROUX, P
我们将205例心肌梗死患者在搭桥术后2 ~ 162个月（平均66个月）住院，与对照组205例心肌梗死患者进行比较，随访时间为34 +-。出院后25个月。在基线时，搭桥后组包含更多的男性（p < 0.03）和更多的既往心肌梗死患者（p < 0.06），但两组在其他方面具有可比性。搭桥后患者的梗死面积指标较低：ST段抬高、QRS评分、血清肌酸激酶（CK）峰值之和（1115 +-）。994比1780。1,647 IU/l)和峰值MB CK(所有p .ltoreq。0.001)。心肌梗死后射血分数为45 +-。旁路术后组为15%，+-组为43%。对照组15% (p = NS)；住院死亡率分别为4%和5% （p = NS）。当考虑到未专利移植物时，两组在冠状动脉疾病的程度上是相当的。出院后5年，旁路治疗组和对照组的累积死亡率相似（分别为30%和25%，p = NS）。然而，与对照组相比，搭桥后患者有更多的再梗死（40比23%，p = 0.007），更多的不稳定型心绞痛入院（23比18%，p = 0.04）和更多的血运重建手术（34比20%，p = 0.04）。在5年内，这些事件的总数在搭桥后组为70%，在对照组为49% （p = 0.001）。因此，虽然既往行搭桥手术的患者发生急性心肌梗死的梗死面积较小，但其后续生存率并不比其他急性心肌梗死患者好。他们会经历更多的再梗死和不稳定型心绞痛。既往搭桥手术是心肌梗死后心脏事件复发的重要临床标志。
A group of 205 patients hospitalized with myocardial infarction 2 to 162 months (mean 66) after bypass surgery and 205 control patients with myocardial infarction were compared and followed up for 34 .+-. 25 months after hospital discharge. At baseline the postbypass group contained more men (p < 0.03) and more patients with previous myocardial infarction (p < 0.06), but the groups were otherwise comparable. Indexes of infarct size were lower in postbypass patients: sum of ST elevation, QRS score, peak serum creatine kinase (CK) (1,115 .+-. 994 versus 1,780 .+-. 1,647 IU/liter) and peak MB CK (all p .ltoreq. 0.001). Postmyocardial infarction ejection fraction was 45 .+-. 15% in the postbypass group and 43 .+-. 15% in the control group (p = NS); in-hospital mortality rate was 4 and 5%, respectively (p = NS). When patent grafts were taken into account, the two groups were comparable in extent of coronary artery disease. At 5 years after discharge, cumulative mortality was similar in the postbypass and control groups (30 versus 25%, respectively, p = NS). However, postbypass patients had more reinfarctions (40 versus 23%, p = 0.007), more admissions for unstable angina (23 versus 18%, p = 0.04) and more revascularization procedures (34 versus 20%, p = 0.04) than did control patients. The total for these events at 5 years was 70% in the postbypass group and 49% in the control group (p = 0.001). Thus, although patients with previous bypass surgery who develop acute myocardial infarction have a smaller infarct, their subsequent survival is no better than that of other patients with acute myocardial infarction. They experience more reinfarctions and unstable angina. Previous bypass surgery is an important clinical marker for recurrent cardiac events after myocardial infarction.