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目的对首次急性心肌梗死（AMI）发生前23h、24～48h、大于48h有无发作过心绞痛的病人的临床状况及近期预后进行评价。方法158例AMI病人分为缺血预适应组46例，其中24h内发生心绞痛11例，24～48h内发生心绞痛6例，大于48h发生心绞痛29例；非预适应组112例；两组基本临床情况相似。结果心肌缺血预适应组比非缺血预适应组心肌梗死范围小（P＜0．01），血浆CPK、LDH、AST峰值低（P＜0．01）、住院期间发生心功能不全、心源性休克、死亡等心脏事件发生率明显减低（P＜0．05）。但大于48h发生心绞痛AMI的梗死面积、CPK、LDH、AST峰值、心脏事件发生率与对照组无显著差异，两者心律失常发生率未见显著差异。结论首次急性心肌梗死前48h以内发作的心绞痛对AMI心肌具有明显的保护作用，其机理可能与心肌缺血预适应有关。
Objective To evaluate the clinical status and short-term prognosis of patients with angina pectoris before 23h, 24 ~ 48h, and 48h after the first acute myocardial infarction (AMI). Methods A total of 158 patients with AMI were divided into ischemic preconditioning group (46 cases), angina pectoris (11 cases) within 24 hours, angina pectoris (24 cases) within 24 ~ 48 hours, angina pectoris (29 cases) over 48 hours, and non-preconditioning group (112 cases) The situation is similar. Results Myocardial ischemic preconditioning group had a smaller range of myocardial infarction than non-ischemic preconditioning group (P <0.01), peak plasma CPK, LDH and AST (P <0.01), cardiac dysfunction, heart failure The incidence of cardiac events such as source shock and death was significantly lower (P <0.05). However, infarction area, CPK, LDH, AST peak and incidence of cardiac events in patients with angina pectoris AMI greater than 48h were not significantly different from those in control group. There was no significant difference in arrhythmia incidence between the two groups. Conclusions Angina pectoris onset within 48 hours before the first acute myocardial infarction has a significant protective effect on AMI myocardium, which may be related to myocardial ischemic preconditioning.