老年急性心肌梗死患者的血脂异常特点

目的探讨老年急性心肌梗死(AMI)患者的血脂异常特点。方法回顾性分析2007年5月至2011年7月该院收治的符合入选标准的AMI患者1 213例。比较老年与非老年以及老年各年龄组间AMI患者各血脂参数〔总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、非高密度脂蛋白胆固醇(N-HDL-C)等〕的差异。结果与非老年组比较,老年组的TC、LDL、TG、TC/HDL-C、LDL-C/HDL-C、TG/HDL-C、N-HDL-C、载脂蛋白B低于非老年组(P=0.000),而HDL-C、脂蛋白(a)、载脂蛋白A高于非老年组(P<0.05)。60⁶9岁女性AMI患者的TC、LDL、HDL、N-HDL-C、载脂蛋白A、载脂蛋白B高于男性;在7069岁女性AMI患者的TC、LDL、HDL、N-HDL-C、载脂蛋白A、载脂蛋白B高于男性;在70⁷9岁老年AMI患者,女性的TC、TG、HDL-C、N-HDL-C、载脂蛋白A高于男性(P<0.05);在≥80岁老年AMI患者,女性的TC、N-HDL-C、载脂蛋白A高于男性(P<0.05)。不同年龄组的老年AMI同性别间比较,6079岁老年AMI患者,女性的TC、TG、HDL-C、N-HDL-C、载脂蛋白A高于男性(P<0.05);在≥80岁老年AMI患者,女性的TC、N-HDL-C、载脂蛋白A高于男性(P<0.05)。不同年龄组的老年AMI同性别间比较,60⁶9岁年龄组的TC、LDL、TG、N-HDL-C高于7069岁年龄组的TC、LDL、TG、N-HDL-C高于70⁷9岁及≥80岁年龄组(P<0.05),但三组间HDL-C无差异(P>0.05),7079岁及≥80岁年龄组(P<0.05),但三组间HDL-C无差异(P>0.05),70⁷9岁组与≥80岁组同性别间各血脂参数无差异(P>0.05)。老年AMI患者的血脂正常比例明显高于非老年AMI患者(20.21%,P<0.05),单纯性低HDL占AMI患者血脂四项联合异常的最大比例。结论老年AMI患者的血脂异常危害暴露水平低于非老年患者。老年AMI各年龄组内女性较男性存在更为严重的血脂异常;低龄老年组的血脂异常较中高龄老年组更为严重。单纯性低HDL-C是老年及非老年AMI患者最常见的血脂组合异常类型。     

老年急性心肌梗死患者近期预后的相关分析

目的探讨老年急性ST段抬高心肌梗死(STEMI)直接PCI患者近期预后的相关分析。方法发病<12h在我院住院且行急诊PCI的STEMI患者805例,依据年龄分为对照组533例(年龄<65岁)和老年组272例(年龄≥65岁),比较2组性别、高血压、糖尿病、发病至PCI时间、TC、TG、LDL-C、HDL-C、入院时血糖、尿酸、同型半胱氨酸、肌酸激酶同工酶酶峰等的差异。结果与对照组比较,老年组年龄、女性、双支病变、心脏不良事件明显增高,收缩压、舒张压、单支病变、TC、TG、LDL-C水平明显降低(P<0.01)。回归分析显示,年龄、性别、TC为STEMI急诊PCI患者近期预后的独立危险因素。结论老年急性心肌梗死直接PCI预后不良,冠状动脉病变多为2~3支,其中年龄、女性、急性期TC水平下降为急性心肌梗死后30d心脏不良事件的独立危险因素。     

老年糖尿病合并急性心肌梗死血脂异常分析

目的　分析老年糖尿病合并急性心肌梗死与血脂异常的关系。　 方法　收集我院老年糖尿病合并急性心肌梗死患者 45例 (Ⅰ组 ) ,无急性心肌梗死的老年糖尿病患者 32例 (Ⅱ组 ) ,老年对照组 2 7例 (Ⅲ组 ) ,检测血脂水平并进行比较。　 结果 　糖尿病合并心肌梗死组血甘油三酯 (TG)、载脂蛋白B明显升高 ,高密度脂蛋白(HDL)、载脂蛋白A1显著降低 ,与Ⅱ组相比 ,差异显著 (P <0 0 1) ,与Ⅲ组相比血TG水平升高 ,HDL降低 (P <0 0 1)。　 结论 　TG升高、HDL降低是老年糖尿病心血管并发症的主要危险因素     

老年人2型糖尿病患者无胸痛性急性心肌梗死临床观察

目的观察老年2型糖尿病患者无胸痛性心肌梗死的临床特点。方法临床确诊的60岁以上老年人2型糖尿病无胸痛性心肌梗死患者作为观察组(A组,41例),老年2型糖尿病心肌梗死伴典型心绞痛患者(B组,49例)及非老年人2型糖尿病心肌梗死伴典型心绞痛患者作为对照组(C组,43例)。比较3组基线临床资料,发作至入院时间、急性心肌梗死发作时的主要临床表现、合并症、并发症、心电图特点,并比较院内病死率。结果 3组临床基线资料比较显示,A组较B、C组患者年龄大[(74±9)岁],糖尿病病程长[(18±5)年],合并疾病比例高,发作至入院诊时间长[(19±13)h](均为P<0.05)。C组男性较A、B组多(88.4%),A、B组间差异无统计学意义(均为P<0.05)。A组以呼吸困难、恶心呕吐、乏力、头晕为主要临床表现,室性心律失常较多见(34.1%)。ECG表现为ST段抬高型心肌梗死较少(31.7%)非sT段抬高型心肌梗死较多(48.8%),梗死部位为下壁(36.6%)和后壁(26.8%)较多。A组病死率为17.1%,B组为8.1%,C组为7.0%。A组病死率较B、C组高,有统计学意义(均为P<0.05)。结论老年人2型糖尿病无胸痛性心肌梗死患者年龄较大,糖尿病病程较长,合并疾病较多,临床症状多变,ECG表现为STEMI较少NSTEMI较多,梗死部位为下壁和后壁较多,病死率较高,临床应提高对其的认识。     

43例糖尿病并发急性心肌梗死患者临床特点分析

目的 探讨糖尿病并发急性心肌梗死的临床特点,提高时该病的认识及诊治的重要性.方法 对我院2003年1月-2009年1月收治的43例糖尿病并发急性心肌梗死患者及同期住院的84例非糖尿病并发急性心肌梗死患者临床资料回顾分析,对比两组年龄、性别、临床表现、梗死部位、并发症的情况有无统计学意义.结果 糖尿病组多部位梗死,并发心力衰竭、室颤、无痛性心肌梗死及非ST段抬高型心肌梗死的比例均明显高于非糖尿病组.结论 糖尿病组并发急性心肌梗死与非糖尿病性心肌梗死相比,无痛性心肌梗死发生率高,呈多部位梗死,非ST段抬高性心肌梗死多见,严重心脏并发症多,住院病死率高,预后差.     

急性心肌梗死院内死亡患者不同入院血糖水平的临床特点

目的:分析急性心肌梗死(AMI)院内死亡患者不同入院血糖水平的临床特点。方法:收集因AMI住院,且期间发生死亡的148例患者,统计发病至死亡时间、入院血糖等资料,其中有入院血糖的有效病例为115例。根据入院血糖将这115例患者分为3组,<7mmol/L组(29例)、7～11mmol/L组(47例)和>11mmol/L组(39例),比较3组患者从发病到死亡时间、梗死部位、死亡原因等有无统计学差异。结果:3组患者发病至死亡时间(P=0.830)、梗死部位(P=0.189)、死亡原因(P=0.255)均差异无统计学意义。结论:对于AMI危重患者,入院血糖并不是影响临床结局的决定性因素。     

老年女性急性心肌梗死的临床特点

目的 探索老年女性急性心肌梗死(AMI)的临床特点。方法 对162例老年AMI患者进行男女比较,分析其患病例数、冠心病危险因素、心脏并发症和死亡率。结果 男女患者比例为1.3:1,但80岁以后女性AMI患者明显多于男性(22.5%比8.8%,P<0.05)。女性和男性糖尿病患病率分别为39.4%和19.8%(P相似文献   

高血压并发急性心肌梗死后血压的变化及临床特点分析

目的分析高血压病人发生急性心肌梗死时血压变化及临床特征。方法把218例急性心肌梗死病人分为A、B两组,合并高血压病人116例归入A组,无高血压病人102例归入B组,对比两组病人发生急性心肌梗死后血压的变化及临床特点。结果无痛性心肌梗死发生率在A组为31.9%,显著高于B组14.7%(P<0.05);血清肌酸激酶峰值在A组为(18±10)×102IU/L,在B组为(13±10)×102IU/L;心肌型肌酸激酶同工酶-MB在A组为(1.5±0.8)×102IU/L,B组为(1.2±0.9)×102IU/L;A组显著高于B组(P<0.05):心肌梗死后血压下降发生率:A组为83.6%,B组为26.5%,差异有统计学意义(P<0.005);收缩压下降:A组为(36±16)mmHg,8组为(14±10)mm。Hg,差异有统计学意义(P<0.01);心功能分级构成比:属心功能Ⅰ级病人在A组和B组分别占42.2%和58.8%,属心功能Ⅱ级病人数两组相似,心功能Ⅲ级以上:A组为28.5%,高于B组12.7%,差异有统计学意义(P<0.05);并发症发生率:A组心力衰竭、严重心律失常、心源性休克、再梗死发生率,住院率及病死率均高于B组。结论高血压病人并发心肌梗死后血压下降发生率及严重程度、并发症及病死率均较血压正常者高,近期预后差,故高血压是影响心肌梗死预后的重要危险因素。     

急性心肌梗死患者早期血糖增高的临床特点及其预后

目的探讨急性心肌梗死(AMI)患者早期血糖增高特点及其预后.方法回顾性分析住院AMI患者206例,分为单纯AMI、合并高血压(HT)、合并2型糖尿病(DM)以及DM合并HT组.观察其心功能(Killip)、恶性心律失常及病死率差别.结果 (1)无DM的AMI患者早期血糖增高出现率为48.2%,多见于女性病人,梗死部位多为前壁;(2)合并显著血糖应激反应的单纯AMI患者其预后较无应者差(住院死亡率25% vs 3.44%,P<0.05),而与AMI+DM+HT或AMI+DM者相近(住院死亡率25% vs 30.77% vs 31.25%, P>0.05 );(3)AMI患者预后与早期血糖水平、心功能和恶性心律失常成正相关(血糖r=0.19,心功能r=0.14,恶性心律失常r=0.40,P均<0.01).结论 AMI早期血糖增高,提示预后差,尤其对合并DM、HT及显著血糖增高者,应积极治疗.     

老年与非老年急性心肌梗死的临床特点比较

目的:分析老年与非老年急性心肌梗死(AMI)的临床特点,以指导治疗。方法:回顾性分析54例老年与35例非老年急性心肌梗死(AMI)患者的临床特点。结果:非老年组男性占88.6％,吸烟占83.9％,饮酒占50.0％,明显高于老年组(P<0.01);血清甘油三酯(TG)水平显著高于老年组(P<0.05);谷草转氨酶(AST)均值大于老年组(P<0.05)。老年组较非老年组心功能差(P<0.005),心率快(P<0.05)。结论:老年与非老年AMI的临床特点不同,在日常生活和治疗时要加以注意。     

Stroke following acute myocardial infarction in diabetics.

To investigate the effect of diabetes on stroke after myocardial infarction (MI), we studied consecutive MI patients admitted to the coronary-care unit prospectively, and compared diabetics with non-diabetics. Seven per cent (11/148) of diabetics and 3% (8/297) of non-diabetics had a stroke within 1 month after MI (P = 0.020). Previous stroke and hypertension were significant risk factors for stroke after MI in diabetics, but there were no significant risk factors in non-diabetics. Hypertension was more frequent in diabetics with (12/14; 86%) than in diabetics without (63/134; 47%) a previous stroke (P less than 0.025). Severe hypotension was more frequent in diabetics (9/11) than in non-diabetics with stroke after MI (0/8) (P = 0.002). We conclude that hypertension is a risk factor for stroke after MI in diabetics, and that may be at risk for hypotensive stroke after MI. Stroke after MI may be more frequent in diabetics than in non-diabetics.     

2型糖尿病合并急性脑梗死与血尿酸及血脂水平的临床分析

目的探讨2型糖尿病合并急性脑梗死与血尿酸及血脂水平的关系。方法选择急性脑梗死患者366例,根据有无糖尿病将患者分为2组,2型糖尿病合并急性脑梗死为糖尿病组163例、无糖尿病的急性脑梗死为对照组203例,测定2组患者血尿酸及血脂水平,分析其与2型糖尿病合并急性脑梗死的相关性。结果与对照组比较,糖尿病组血清尿酸水平明显升高,差异有统计学意义[(414.41±45.74)μmol/Lvs(370.54±42.37)μmo1/L,P<0.05];糖尿病组TC、TG、LDL-C水平明显升高,差异有统计学意义(P<0.05,P<0.01)。logistic多元相关分析,糖尿病与血尿酸水平呈负相关(r=-0.484,P=0.017)。结论高尿酸血症和高脂血症是2型糖尿病合并急性脑梗死的危险因素。     

女性ST段抬高心肌梗死患者临床特点和近期预后分析

目的评价女性ST段抬高心肌梗死患者的临床特点、住院期间心脏不良事件发生和病死率。方法入选我院1994年1月～2006年12月初发急性ST段抬高心肌梗死患者1233例,男性901例,女性332例,对两者临床特点、危险因素、住院并发症和病死率进行比较。结果与男性比较,女性患者年龄偏高,发病至就诊时间长,非典型症状多见;女性患者高血压、糖尿病、高脂血症、具有多重危险因素患者的比例高于男性(P0.05,P0.01);女性患者入院后接受再灌注治疗的比例低于男性;女性患者住院期间发生心力衰竭和病死率明显高于男性。结论女性心肌梗死患者临床特点、接受有效治疗的比例、住院期间预后均较男性差。     

Traditional risk factors and acute myocardial infarction in patients hospitalized with cocaine-associated chest pain

BACKGROUND: Cocaine causes coronary artery constriction and may cause acute myocardial infarction (AMI). The role of traditional coronary risk factors in cocaine-associated myocardial infarction is unclear. HYPOTHESIS: We hypothesized that traditional risk factors play a major role in predicting AMI in patients admitted with cocaine-associated chest pain METHODS: After reviewing 165 admissions for chest pain in patients with a history of recent cocaine use and/or a positive drug screen from January 2001 to December 2004, we identified 151 patients with information available on at least 6 of the following 7 risk factors: gender, hypertension, hyperlipidemia, diabetes, smoking, family history of coronary artery disease (CAD) and known CAD. AMI was diagnosed using WHO criteria. A risk score was calculated on the basis of the number of risk factors, gender and age. Association of AMI was evaluated with the individual risk factors and with the risk score. RESULTS: AMI was identified in 21 patients (14%). All patients diagnosed with AMI were smokers. Continuous risk score (p < 0.0001), highest vs. lowest quartile of risk score (p = 0.007), known CAD, age, hyperlipidemia and family history of CAD were individually associated with the diagnosis of AMI (p>or=0.05). Each quartile of risk score was associated with increased odds of the diagnosis of AMI and score of 8 or higher was statistically significant. CONCLUSION: Several traditional risk factors are associated with the diagnosis of AMI among patients hospitalized with cocaine-associated chest pain and increasing risk factor score was associated with increasing odds of AMI diagnosis.     

低钾血症对急性心肌梗死患者预后的影响

目的探讨急性心肌梗死(AMI)患者低钾血症的发生情况及其对预后的影响。方法对929例ST段抬高的AMI患者于入院时抽血测定血钾、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI),根据血钾水平分为低血钾组(血钾<3.5 mmol/L)和正常血钾组(血钾3.5~5.5 mmol/L),同时观察住院期间严重不良事件(室性心动过速、心室颤动和猝死)的发生情况。结果低钾血症的发生率为13.7%,下壁+后壁AMI的发生率最低(10.4%),明显低于下后壁+右心室、前间壁和广泛前壁心肌梗死;发病至抽血时间≤3 h的低钾血症发生率为17.3%,明显高于发病时间>3 h者;低血钾组的CK、CK-MB和cTnI峰值明显高于正常血钾组;低血钾组总的严重不良事件发生率(23.8%)明显高于正常血钾组(15.8%)。结论低钾血症与AMI患者的梗死时间、部位和面积相关,并严重影响患者的预后。     

缺血后适应对老年急性心肌梗死患者的影响

目的观察缺血后适应(IPO)对急性心肌梗死(AMI)患者PCI后心肌灌注和临床事件的影响。方法选取12h内接受急诊PCI的老年AMI患者122例,分为对照组87例和IPO组35例。对照组梗死相关血管再通后,不施加干预;IPO组梗死相关血管再通后1 min内应用低气压充盈和回撤球囊,每一过程各30s,术后测定血肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、丙二醛,观察ST段回落,冠状动脉血流速度、住院期间临床事件发生情况。结果 IPO组CK、CK-MB和丙二醛峰值明显低于对照组(P<0.05);IPO组冠状动脉血流速度明显快于对照组(P<0.05),术后ST段回落>50%者明显高于对照组(74.3%vs 54.0%,P<0.05),再灌注心律失常发生率明显低于对照组(P<0.05)。结论 IPO可以缩小心肌梗死面积、减少自由基的生成,改善PCI后冠状动脉血流速度,改善心肌灌注,减少再灌注心律失常的发生。     

Circadian rhythm and clinical characteristics in patients with acute myocardial infarction combined with obstructive sleep apnea

ObjectiveThe present study aimed to investigate the circadian rhythm and clinical characteristics of patients with acute myocardial infarction (AMI) combined with obstructive sleep apnea (OSA).MethodsPatients with AMI combined with OSA were enrolled in the study, and those that met the inclusion criteria were divided into three time‐period groups based on their sleep–wake rhythm (22:00–5:59, 6:00–13:59, and 14:00–21:59). The differences between the three groups of patients in sleep‐monitoring data, blood routine, biochemical indicators, and coronary angiographic parameters were analyzed and compared. Count data were expressed as the number of cases, and the chi‐square test was used for statistical analysis. Continuous data were expressed as mean ± standard deviation, and analysis of variance was used for the statistical analysis of these data. The characteristics of circadian rhythm and clinical features in patients with AMI combined with OSA were analyzed.ResultsOf the 148 patients, 90/148 (61%) had chest pain and 58/148 (39%) had non‐chest pain symptoms. In the 22:00–05:59 group, there were 70/148 (47%) patients with AMI (of these, 46/70 [66%] had chest pain). In the 06:00–13:59 period group, there were 44/148 (30%) patients with AMI (of these, 26/44 [60%] had chest pain). In the 14:00–21:59 period group, there were 34/148 (23%) patients with AMI (of these, 17/34 [50%] had chest pain). There was no statistically significant difference in the apnea–hypopnea index (AHI) and SYNTAX score between patients in the 22:00–5:59 and 6:00–13:59 groups. However, the AHI and SYNTAX scores in the 22:00–5:59 and 6:00–13:59 groups were higher than those in the 14:00–21:59 group, and the differences were statistically significant. In patients in the 22:00–5:59 group, the levels of serum D‐dimer (DD), hemoglobin (Hb), and oxygen desaturation index (ODI3) were higher, the sleep mean oxygen saturation (MeanSaO₂) was lower and the percentage of nighttime spent with oxygen saturation of less than 90% (Tsat₉₀) and less than 85% (Tsat₈₅) was longer.ConclusionThe peak period for the onset of AMI in patients with OSA was 22:00–5:59, and the incidence of chest pain was high. During this period, patients had higher DD and Hb, higher ODI3, lower MeanSaO₂ during sleep, and longer TSat₉₀ and TSat₈₅. During the 22:00–5:59 and 6:00–13:59 periods, patients had higher AHI and a higher SYNTAX score.     

Prognosis for patients with initially suspected acute myocardial infarction in relation to presence of chest pain.

In all 4,232 patients admitted to a single hospital during a 21-month period due to initially suspected acute myocardial infarction (AMI), the prognosis and risk factor pattern were related to whether patients had chest pain or not. Symptoms other than chest pain that raised a suspicion of AMI were mainly acute heart failure, arrhythmia, and loss of consciousness. In 377 patients (9%) symptoms other than chest pain raised an initial suspicion of AMI. These patients developed a confirmed infarction during the first three days in hospital with a similar frequency (22%) as compared with patients having chest pain (22%). However, patients with "other symptoms" had a one-year mortality of 28% versus 15% for chest pain patients (p less than 0.001). Patients with "other symptoms" more often died in association with ventricular fibrillation and less often in association with cardiogenic shock as compared with chest pain patients. Among the 921 patients who developed early AMI, 64 (7%) had symptoms other than chest pain. They had a one-year mortality of 48% versus 27% for chest pain patients (p less than 0.001). We conclude that in a nonselected group of patients hospitalized due to suspected AMI, those with symptoms other than chest pain have a one-year mortality, which is nearly twice that of patients with chest pain.     

Five-year risk of developing clinical diabetes after first myocardial infarction; the FINAMI study.

AIM: To investigate the incidence of clinical diabetes as determined by the incidence of diabetes drug reimbursements within a 5-year period after the first myocardial infarction (MI) in patients who were non-diabetic at the time of their first MI. RESEARCH DESIGN AND METHODS: A population-based MI register, FINMONICA/FINAMI, recorded all coronary events in persons of 35-64 years of age between 1988 and 2002 in four study areas in Finland. These records were used to identify subjects sustaining their first MI (n = 2632). Participants of the population-based risk factor survey FINRISK (surveys 1987, 1992, 1997 and 2002), who did not have diabetes or a history of MI, served as the control group (n = 7774). The FINMONICA/FINAMI study records were linked with the National Social Security Institute's drug reimbursement records, which include diabetes medications, using personal identification codes. The records were used to identify subjects who developed diabetes during the 5-year follow-up period (n = 98 in the MI group and n = 79 in the control group). RESULTS: Sixteen per cent of men and 20% of women sustaining their first MI were known to have diabetes and thus were excluded from this analysis. Non-diabetic men having a first MI were at more than twofold {hazard ratio (HR) 2.3 [95% confidence interval (CI) 1.6-3.4]}, and women fourfold [HR 4.3 (95% CI 2.4-7.5)], risk of developing diabetes mellitus during the next 5 years compared with the control population without MI. CONCLUSIONS: Many patients who do not have diabetes at the time of their first MI develop diabetes in the following 5 years.