LEFT-VENTRICULAR END-SYSTOLIC VOLUME AS THE MAJOR DETERMINANT OF SURVIVAL AFTER RECOVERY FROM MYOCARDIAL-INFARCTION
LEFT-VENTRICULAR END-SYSTOLIC VOLUME AS THE MAJOR DETERMINANT OF SURVIVAL AFTER RECOVERY FROM MYOCARDIAL-INFARCTION
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DOI：
10.1161/01.cir.76.1.44
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发表时间：
1987-07-01
期刊：
影响因子：
37.8
通讯作者：
WILD, CJ
中科院分区：
文献类型：
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作者：
WHITE, HD;NORRIS, RM;WILD, CJ
左心室功能受损是急性心肌梗死后死亡率的主要预测因素，但尚不清楚是否最好用射血分数或收缩末期或舒张末期容积来描述。我们测量了605例60岁以下男性患者首次（n = 443）或复发（n = 162）心肌梗死后1 - 2个月的冠状动脉闭塞和狭窄的容积、射血分数和严重程度，并对这些患者的存活者进行了平均78个月的随访（范围15 - 165个月）。有101例心源性死亡，其中71例（70%）为突然死亡（瞬时死亡或发现死亡）。多变量分析采用对数秩检验和考克斯比例风险模型，结果显示收缩末期容积（χ 2 = 82.9）比舒张末期容积具有更大的存活预测价值（χ 2 = 59.0）或射血分数（χ 2 = 46.6），而逐步分析显示一旦生存和收缩末期容积之间的关系被拟合，在舒张末期容积或射血分数中没有额外的显著预测信息。冠状动脉闭塞和狭窄的严重程度显示了额外的预测，只有边缘意义（在一项分析中p = 0.04），但在逐步分析后，继续吸烟仍然是一个独立的危险因素。对于一个参加了一项随机试验的患者子集（n = 200），他们在梗死恢复后接受了冠状动脉手术，手术的“意向治疗”没有显示出预测价值。我们的结论是，对于预测，收缩末期容积是心肌梗死后生存的主要预测因子，当射血分数低（< 50%）或收缩末期容积高（< 100 ml）时，其上级优于射血分数。梗死的治疗应以限制梗死范围和防止心室扩张为目标。
Impairment of left ventricular function is the major predictor of mortality after acute myocardial infarction, but it is not known whether this is best described by ejection fraction or by end-systolic or end-diastolic volume. We measured volumes, ejection fractions, and severity of coronary arterial occlusions and stenoses in 605 male patients under 60 years of age at 1 to 2 months after a first (n = 443) or recurrent (n = 162) myocardial infarction and followed these patients for a mean of 78 months for survivors (range 15 to 165 months). There were 101 cardiac deaths, 71 (70%) of which were sudden (instantaneous or found dead). Multivariate analysis with log rank testing and the Cox proportional hazards model showed that end-systolic volume (.chi.2 = 82.9) had greater predictive value for survival than end-diastolic volume (.chi.2 = 59.0) or ejection fraction (.chi.2 = 46.6), whereas stepwise analysis showed that once the relationship between survival and end-systolic volume had been fitted, there was no additional significant predictive information in either end-diastolic volume or ejection fraction. Severity of coronary occlusions and stenoses showed additional prediction of only borderline significance (p = .04 in one analysis), but continued cigarette smoking did remain an independent risk factor after stepwise analysis. For a subset of patients (n = 200) who had taken part in a randomized trial of coronary artery surgery after recovery from infarction, surgical "intention to treat" showed no predictive value. We conclude that for prediction, end-systolic volume is the primary predictor of survival after myocardial infarction, being superior to ejection fraction when ejection fraction is low (< 50%) or when end-systolic volume is high (< 100 ml). Treatment of infarction should be aimed at limitation of infarct size and prevention of ventricular dilation.