心血管造影所見よりみた心筋梗塞の自然歴

Natural history of 120 patients who had suffered from myocardial infarction and who underwent coronary arteriography and left ventriculography

はじめに

　急性心筋梗塞による死亡は発症から入院までの間が最も多く，入院後も数日間は不整脈，心不全，心原性ショック，心破裂などの重症合併症による危険にさらされている。最近はCCUの普及に伴い，急性期ポンプ失調や心破裂等の特殊な症例を除けば，かなり救命率が高くなっている。また，急性心筋梗塞の大半は重症合併症を伴わずに順調に経過し，社会復帰が行なわれているようである。しかし，急性期の救命や入院中のリハビリテーションのあり方などに関しては，かなり積極的に議論が展開^1,2）されつつある反面，退院後の患者における自然歴に関しては，症例各々の背景があまりにも異なっているためか，なかなか把握しにくいのが現状と思われる。

　我々は，急性期死亡をまぬがれて退院した急性心筋梗塞のうち，内科的管理を行なった症例について，心血管造影所見と自然歴との対比検討を行なったので報告する。

Coronary arteriography and left ventriculogra-phy were performed in 172 patients who had survived from attacks of acute myocardiali nfarction during 1974 to 1978. Of these, 120 non-operated patients were evaluated. The infarcted sites of these cases were anterior in 51, inferior in 42, antero-inferior in 13, high posterior in 9, lateral in 3 and subendocardial in 2 patients.

Death from coronary disease occurred in 12 (10%), a second non-fatal myocardial infarction occurred in 6(5%) and angina developed in another 6 patients (5%).

In all patients, these ischemic events after hospital discharge were independent of infarct size and contractility of the non-infarct area. However, cardiac death especially occurred in patients with large infarcts, low contractility of the non-infarcted area and significant disease in two or three coronary arteries.

Meanwhile, progression of the disease in the remaining coronary arteries is also one of the important factors which influence the natural history of patients who have suffered from acute myocardial infarction.