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目的 急性心肌梗死（心梗） 后５ 年随访期间比较各种因素对死亡率影响，探讨卡托普利早期长期治疗的预后意义。方法 ８２２ 例首次急性心梗后７２ 小时内入院且无心源性休克患者中，４７８ 例早期并长期持续应用卡托普利和常规治疗（ 治疗组） ，３４４ 例仅常规治疗（ 对照组） 。用Ｃｏｘ 回归方法作多因素分析，ＫａｐｌａｎＭｅｉｅｒ法分析两组随访期累积生存率和心源性事件发生率。结果 年龄、Ｋｉｌｌｉｐ 分级（ ≥Ⅱ级）、前壁梗死、糖尿病、ＣＰＫ高峰浓度相对危险性＞１ ，卡托普利、β受体阻滞剂、血小板拮抗药和静脉溶栓相对危险性＜ １ 。治疗组随访各阶段累积生存率高于对照组（ Ｐ＜ ０．００１） ，心源性事件累积发生率低于对照组（ Ｐ＜ ０ ．０００１）。结论 早期长期卡托普利治疗急性心肌梗死患者对其预后具有益作用。
Objective To investigate the effect of various factors on mortality after 5-year follow-up of acute myocardial infarction (MI) and to explore the prognostic significance of early long-term treatment of captopril. Methods Among the 822 patients admitted to hospital within 72 hours after the first acute myocardial infarction and without cardiogenic shock, 478 patients were treated with captopril and conventional therapy in the early and long term, and 344 patients in the control group only. The Cox regression method was used for multivariate analysis. Kaplan-Meier method was used to analyze the cumulative survival rate and the incidence of cardiac events during follow-up period. Results The relative risk of peak concentration of Kaplan-Meier, β-blockers, platelet antagonists and intravenous thrombolysis was less than 1 in Killip classification (≥Ⅱgrade), anterior wall infarction, diabetes and CPK peak concentration . The cumulative survival rate in each phase of the treatment group was higher than that of the control group (P <0.001), and the cumulative incidence of cardiac events was lower than that of the control group (P <0 .0001). Conclusion Early long-term captopril treatment of patients with acute myocardial infarction has a beneficial effect on its prognosis.