冠状动脉造影正常的急性心肌梗塞的临床分析

Clinical analysis of acute myocardial infarction without angiographically coronary artery stenosis

目的研究无明显冠状动脉狭窄的急性心肌梗死(Acute Myocardial Infarction AMI)患者的临床特点,并进一步探讨其发生机制。方法将398例首次AMI患者按冠状动脉造影(CAG)结果分为冠状动脉造影狭窄组(直径狭窄程度≥50%)和冠状动脉造影正常组(直径狭窄程度<50%),比较分析二组的冠心病相关危险因素及临床情况。结果398例AMI患者中冠状动脉造影正常者31例,占心肌梗死患者的7.79%(31/398)。二组在糖尿病、高脂血症、高血压等方面差异无统计学意义。与冠状动脉造影狭窄组比较,冠状动脉造影正常组的AMI患者在少于40岁的比例(71.0%对46.5%p<0.005)、吸烟(71.0%对56.5%p<0.005)和有诱发因素(67.7%对25.9%p<0.005)等方面的差异有统计学意义;住院期间左室射血分数(LVEF)≥50%的比例较高(70.1%对45.2%,P<0.05),而梗塞后心绞痛发生率较低(20.1%对40.3%,P<0.05)。结论冠状动脉无明显狭窄的AMI患者心功能较好,在年轻人及吸烟者相对多见,常伴有诱发因素。

Objectivo To analyze the risk factors and follow-up in acute myocardial infarction （AMI） patients without angiographically coronary artery stenosis, and elucidate the possible mechanisms. Methods Selective coronary angiography was performed on 398 patients who had first AMI. They were divided into two groups in terms of severity of coronary lesion：the group with normal angiographically coronary artery （coronary artery diameter stenosis percentage less than 50%） and the group with angiographically coronary stenosis （coronary artery diameter stenosis percentage equal to or more than 50%）. The risk factors, clinical data and ventricular functions were compared between the two groups. Results 7.78%（31/398）cases showed normal angiographically coronary artery. There were no statistical differences between the two groups in terms of diabetes and hyperlipemia or hypertension. Compared with the group with angiographically coronary stenosis, the group with normal angiographically coronary artery had higher scale in three sides including aged less than 40 （71. 0%vs46.5%p〈0. 005）, smoking or not（71.0%vs56.5%p〈0. 005）, induced factors（67.7%vs25.9%p〈0. 005）, which had statistical significance. Left ventricular ejection fraction （LVEF）≥ 50%was prevented more in the group with normal angiographically coronary artery（70.1%vs45.2%, P〈0.05）, and post-myocardial infarction angina was lower （20.1%vs40.3%,P〈0.05）. Conclusion AMI without angiographically coronary artery stenosis has better left venteicular function, and there is a higher prevalence in young patients and smokers associated with induced factors.