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目的 :为了研究梗塞前心绞痛 (AP)对老年急性心肌梗塞 (AMI)预后的影响。方法 :作者对 186例AMI患者 (老年人 118例 ,老年前期 68例 ) ,观察AMI前 4 8h有无AP发作 ,分为AP(+ )和AP(- )组 ,分析两组病人的预后。结果 :在 <60岁的AMI患者中 ,梗塞前AP可降低AMI患者 1月内充血性心衰 (CHF)、心源性休克和心源性死亡率 (P<0 .0 1) ;CK峰值降低 ,达峰时间缩短 (P <0 .0 1) ;高危性室性心律失常 ,高度房室传导阻滞 (AVB)及左室射血分数(LVEF)≤ 3 5 %者均减少 (均P <0 .0 5 )。在老年患者中 ,AMI前有AP发作和无AP发作者 1月内CHF、心源性休克和心源性死亡率比较无统计学差异 (P >0 .0 5 ) ;无AP发作者CK峰值显著升高 (P<0 .0 1) ;广泛前壁心梗和高度AVB者增多 (P <0 .0 5 ) ;随访中 ,远期心源性死亡率增加 (18 0 %vs 5 .9% ;P <0 .0 5 )。结论 :梗塞前心绞痛能改善AMI的预后。
Objective: To investigate the effect of pre-infarction angina (AP) on the prognosis of elderly patients with acute myocardial infarction (AMI). Methods: A total of 186 patients with AMI (118 elderly patients and 68 elderly patients) were divided into two groups: AP (+) and AP (-) groups. The prognosis of the two groups was analyzed. Results: In AMI patients <60 years of age, pre-infarction AP decreased CHF within 1 month, cardiogenic shock and cardiac mortality (P <0.01); peak CK (P <0.01); high-risk ventricular arrhythmia, high AVB and LVEF ≤ 35% decreased (P <0 .0 5). There were no significant differences in CHF, cardiogenic shock and cardioembolic death among elderly patients with AP episodes and without AP episodes before AMI (P> 0.05); peak CK without AP episodes (P <0.01); the number of anterior wall myocardial infarction and high AVB increased (P <0.05); the mid-term and long-term cardiogenic mortality increased (18 0% vs 5.9 %; P <0. 05). Conclusion: Pre-infarction angina improves the prognosis of AMI.