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目的:研究心肌梗死前心绞痛对急性心肌梗死溶栓治疗患者住院预后的影响。方法:收集近5年来112例在我院进行溶栓治疗的急性心肌梗死患者完整资料,根据患者有无在心肌梗死前1周内心绞痛发作分为梗死前心绞痛(PA)组和非梗死前心绞痛(NPA)组。统计分析梗死前心绞痛与住院期间预后关系。结果:PA组和NPA组在部分基线特征上存在差异,PA组女性多于NPA组(45%∶24%,P<0·05),合并高血压在PA组更多(66%∶45%,P<0·05);氯吡格雷的使用在NPA组多于PA组(77%∶53%,P<0·01);PA组有更低的溶栓再通率(47%∶76%,P<0·01)和更高的死亡率(21%∶5%,P<0·05),而非死亡并发症的出现在二组间无明显差异(21%∶30%,P>0·1)。Logistic回归分析表明,多因素分析时PA为溶栓再通的独立危险因素(P<0·01);单因素分析时梗死前心绞痛为预测死亡的危险因素(P<0·01),而多因素分析则无明显相关(P>0·1)。结论:心肌梗死前1周内发生的心绞痛减少急性ST段抬高心肌梗死溶栓患者的再通率,可能增加患者住院期间的死亡风险。
Objective: To study the influence of pre-myocardial infarction angina on in-hospital prognosis in patients with acute myocardial infarction thrombolytic therapy. Methods: The complete data of 112 patients with acute myocardial infarction who underwent thrombolytic therapy in our hospital in recent 5 years were collected. According to whether the patients had angina pectoris during the first week before myocardial infarction, they were divided into pre-infarction angina (PA) group and non-infarction angina pectoris (NPA) group. Statistical Analysis of Preinfarction Angina Pectoris and Prognosis in Hospital. Results: There were some differences in baseline characteristics between PA group and NPA group. PA group had more females than NPA group (45% vs 24%, P <0.05) , P <0.05). The use of clopidogrel was more in the NPA group than in the PA group (77%: 53%, P <0.01) %, P <0.01) and higher mortality (21%: 5%, P <0.05), while the incidence of non-fatal complications was not significantly different between the two groups (21% vs 30%, P > 0 · 1). Logistic regression analysis showed that PA was an independent risk factor for thrombolysis recanalization in multivariate analysis (P <0.01); univariate analysis showed that pre-infarction angina was a predictor of mortality (P <0.01) Factor analysis was not significantly related (P> 0 1). CONCLUSION: Angina pectoris occurring within 1 week prior to myocardial infarction reduces the recanalization rate of thrombolytic patients with acute ST-segment elevation myocardial infarction and may increase the risk of death during hospitalization.