在美国,急性心肌梗死患者约 15% 会死于该疾病,其中半数死亡发生在症状发作一小时内。[2]Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26;133(4):e38-360.https://www.ahajournals.org/doi/10.1161/CIR.0000000000000350?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#http://www.ncbi.nlm.nih.gov/pubmed/26673558?tool=bestpractice.com STEMI 患者的预后取决于胸痛发作到就诊的时间以及就诊到接受治疗的时间。早期接受再灌注治疗、坚持合适的药物治疗以及控制危险因素,可以改善预后。肌钙蛋白水平升高的患者较正常者预后要差。[21]Setiadi BM, Lei H, Chang J. Troponin not just a simple cardiac marker: prognostic significance of cardiac troponin. Chin Med J (Engl). 2009 Feb 5;122(3):351-8.http://www.ncbi.nlm.nih.gov/pubmed/19236818?tool=bestpractice.com 遵守循证医学治疗可以给患者带来更好的结局。[71]Amin A. Improving the management of patients after myocardial infarction, from admission to discharge. Clin Ther. 2006;28:1509-1539.http://www.ncbi.nlm.nih.gov/pubmed/17157110?tool=bestpractice.com 5%-10% 的患者可能发生院内死亡和再梗死。[72]Grech ED, Ramsdale DR. Acute coronary syndrome: ST segment elevation myocardial infarction. BMJ. 2003;326:1379-1381.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126253/http://www.ncbi.nlm.nih.gov/pubmed/12816828?tool=bestpractice.com 大出血(根据出血学术研究联合会 [Bleeding Academic Research Consortium, BARC] 或心肌梗死中的血栓形成 [Thrombolysis in Myocardial Infarction, TIMI] 出血评分)可导致 1 年死亡率升高。[73]Kikkert WJ, van Geloven N, van der Laan MH, et al. The prognostic value of bleeding academic research consortium (BARC)-defined bleeding complications in ST-segment elevation myocardial infarction: a comparison with the TIMI (Thrombolysis In Myocardial Infarction), GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries), and ISTH (International Society on Thrombosis and Haemostasis) bleeding classifications. J Am Coll Cardiol. 2014;63:1866-1875.http://www.ncbi.nlm.nih.gov/pubmed/24657697?tool=bestpractice.com