老年急性非ST段抬高型心肌梗死临床特点分析

摘要

To analyze clinical features of aged patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods: A total of 43 acute NSTEMI patients in our hospital from Jan 2008 to Dec 2010 were retrospectively analyzed for their clinical features, Results: Among 43 acute NSTEMI patients: (1) Risk factors and medical history- There were 38 cases (88. 4%) complicated with two to four risk factors, 40 cases (93. 0%) with angina pectoris history, 14 cases (32.6%) with old myocardial infarction; (2) Clinical manifestations: There were 36 cases (83. 7%) with chest pain, 35 cases (81.3%) with NYHA cardiac function class 2~3, 40 cases (93.1%) with ST-T change in ECG, 43 cases (100.0%) with cardiac troponin T (cTnT) level elevated and 32 cases (74.4%) with creatine kinase isoenzyme (CK-MB) level elevated ≥2 times; (3) Coronary angiography: a total of 37 cases (100%) were single or multiple-vessel coronary disease, 35 cases (94. 6%) with multiple vessel coronary diseases (4) Treatment, complications and prognosis: Based on routine medicinal treatment, 31 cases (72.1%) underwent PCI, three cases (7.0%) underwent coronary artery bypass graft (CABG). There were 13 cases (30.2%) with acute left ventricular failure, five cases (11. 6%) with cardiogenic shock, five cases (11. 6%) with severe arrhythmias and six cases (14.0%) died. Conclusion: The aged acute NSTEMI patients usually complicated with many risk factors of coronary heart disease, multiple vessel coronary disease and cardiac insufficiency, their revascularization rate is high, long-tern prognosis is poor.%目的:分析老年非ST段抬高型心肌梗死(NSTEMI)患者的临床特点.方法:回顾分析我院2008年1月至2010年12月43例急性NSTEMI患者的临床特点.结果:43例急性NSTEMI患者中,(1)危险因素及病史:38例(88.4％)患者伴有2～4个危险因素,40例(93.0％)有心绞痛病史,14例(32.6％)有陈旧性心肌梗死;(2)临床表现:36例有胸痛(83.7％),35例(81.3％) NYHA心功能2-3级,40例(93.1％)心电图见ST-T段改变,43例(100.0％)心肌肌钙蛋白T水平升高,32例(74.4％)肌酸激酶-同工酶水平升高≥2倍;(3)冠脉造影检查,37例(100％)均有单支或多支病变,多支病变患者35例(94.6％);(4)治疗、合并症及预后:在常规内科药物治疗基础上,31例(72.1％)行PCI治疗,3例(7.0％)行冠状动脉旁路移植术,合并急性左心衰竭13例(30.2％),心源性休克5例(11.6％),恶性心律失常5例(11.6％),死亡6例(14.0％).结论:老年非ST段抬高心肌梗死患者合并冠心病的危险因素多,多支病变常见,心功能不全多见,血运重建率高,远期预后较差.