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目的 :探讨既往心绞痛史与急性心肌梗死 (AMI)患者近期预后的关系。 方法 :12 97例首次急性心肌梗死患者 ,按既往有无心绞痛史分为A (无心绞痛史 )、B (有心绞痛史 ) 2组 ,比较 2组间院内病死率、死亡原因及存活患者心功能的差异。 结果 :①B组院内病死率显著低于A组 (5 15 %vs .11 72 % ,P <0 0 0 1) ;②B组患者因心源性休克或心力衰竭而死亡的比例略低于A组 (3 40 %vs .5 73 % ,P =0 0 5 ) ,因心脏破裂而死亡的比例显著低于A组 (0 87%vs .4 69% ,P<0 0 0 1) ;③存活患者出院时 ,B组NYHA心功能分级和左心室射血分数 (LVEF)均明显优于A组 (NYHA 1 2 5±0 5 5vs .1 40± 0 67,P <0 0 1;LVEF 0 5 2 3± 0 12 2vs .0 486± 0 10 9,P <0 0 1)。 结论 :既往有心绞痛史的急性心肌梗死患者近期预后相对较好 ,原因可能与既往心绞痛促进冠状动脉侧支循环形成及缺血预适应机制有关。
Objective: To investigate the relationship between the past history of angina pectoris and the recent prognosis of patients with acute myocardial infarction (AMI). Methods: A total of 12 97 patients with first acute myocardial infarction were divided into two groups according to the past history of angina: history of angina pectoris (without angina pectoris) and history of angina pectoris (angina pectoris). The hospital mortality, causes of death and cardiac function in surviving patients were compared The difference. Results: ①The mortality in hospital was significantly lower in group B than in group A (5 15% vs. 11 72%, P 0 01); ② The proportion of death in group B due to cardiogenic shock or heart failure was slightly lower than that in group A (3 40% vs. 73%, P = 0 05). The death rate due to heart rupture was significantly lower than that in group A (0 87% vs. 69%, P 0 01). ③ The survivors At discharge, NYHA functional class and left ventricular ejection fraction (LVEF) in group B were significantly better than those in group A (NYHA 1 2 5 ± 0 5 5 vs 1 40 ± 0 67, P 0 01; LVEF 0 5 2 3 ± 0 12 2 vs. 0 486 ± 0 10 9, P <0 0 1). Conclusion: The recent prognosis of patients with acute myocardial infarction with previous history of angina is relatively good. The reason may be related to the previous angina pectoris promoting the formation of coronary collateral circulation and ischemic preconditioning mechanism.