探讨首发急性心肌梗死(AMI)与再发急性心肌梗死(RMI)的先兆诱因及临床特征。

对符合国际心脏病学会及WHO关于AMI诊断标准的145例患者临床资料进行分析，依临床表现分为首发急性心肌梗死组(首发组)、再发急性心肌梗死组(再发组)，分析其先兆诱因、临床特征。

首发组前壁梗死的发生率显著高于再发组(62.03%，59.64%，χ²＝8.65，P<0.01)，而下后壁梗死发生率两组差异无统计学意义(37.97%，40.50%，χ²＝0.21，P>0.05)；再发组患者有家族史(32.43%)、焦虑抑郁情绪(51.35%)者显著大于首发组(16.61%，20.37%；χ²＝6.56，3.81；P<0.05)，而再发组吸烟者(29.73%)则显著低于首发组(51.58%，χ²＝3.88，P<0.05)；再发组患者心力衰竭(43.24%)、恶性心律失常(27.03%)、死亡(18.92%)的发生率显著大于首发组(20.37%，17.95%，7.40%, χ²＝3.81，5.79，18.69；P<0.05)。再发组患者非原位再梗死恶性心律失常(42.88%)、死亡的发生率(21.43%)显著大于原位再梗死者(13.04%，17.39%，χ²＝5.88，4.50；P<0.05)。

RMI患者心肌梗死危险因素中有家族史、有焦虑抑郁情绪者显著大于首发AMI患者；RMI患者心肌梗死后心力衰竭、恶性心律失常、死亡的比例较高；RMI患者非原位再梗死后恶性心律失常、死亡的比例显著大于原位再梗死者。

To explore foreboding inducement and clinical features of patients with first and recurrent acute myocardial infarction.

One hundred and forty-five patients with acute myocardial infarction who conformed to the diagnostic criteria of International Congress of Cardiology and World Health Organization (WHO) were enrolled.Patients were divided into first acute myocardial infarction (primary group) and recurrent acute myocardial infarction (recurrence group). The foreboding inducement and clinical features were analyzed.

Incidence rate of anterior infarction in primary group was higher than that in recurrence group (62.03%, 59.64%, χ²=0.21, P<0.01). Incidence rate of inferoposterior myocardial infarction in primary group (37.97%) was lower than that in recurrence group (40.50%), but the difference was not significant (χ²=8.65, P>0.05). The proportions of family history (32.43%) and anxiety-depression emotion (51.35%) in recurrence group were obviously bigger than those in primary group (16.61%, 20.37%, χ²=6.56, 3.81; P<0.05), but the ratio of smoking in recurrence group (29.73%) was lower than that in primary group (51.58%, χ²=3.88, P<0.05). The incidence rates of heart failure (43.24%), malignant arrhythmia (27.03%) and death (18.92%) in recurrence group were larger than those in primary group (20.37%, 17.95%, 7.40%), there were significant differences between the two groups (χ²=3.81, 5.79, 18.69; P<0.05). Meanwhile, the incidence rates of malignant arrhythmia (42.88%), death (21.43%) in ex-situ myocardial infarction patients were significant higher than those in in-situ myocardial infarction patients (13.04%, 17.39%, χ²=5.88, 4.50; P<0.05) in recurrence group.

The proportions of family history and anxiety-depression emotion in recurrence group are obviously higher than those in primary group.The incidence rates of heart failure, malignant arrhythmia and death in recurrence group are significant.The incidence rates of malignant arrhythmia and death in ex-situ myocardial infarction patients are more higher than those in in-situ myocardial infarction patients in recurrence group.