冠状动脉造影正常的急性心肌梗死临床分析

Acute Myocardial Infarction With Nomal Coronary Angiogram-A Clinical Analysis

目的 探讨冠状动脉 (冠脉 )造影正常的急性心肌梗死 (AMI)的主要危险因素和预后。方法 从 1996年7月至 2 0 0 3年 8月对AMI行冠脉造影 5 30例中发现造影正常AMI 2 2例 ,按年龄将其分成中年人和老年人两组 ,并比较两者主要危险因素和预后。结果 冠脉造影正常的AMI 2 2例。中年人组 :13例 ,高血压 7/ 13,长期大量吸烟 8/ 13;老年人组 :9例 ,高血压 9/ 9,长期大量吸烟 3/ 9,两组有明显统计学差异。而高胆固醇血症、糖尿病、大量饮酒史比较 ,无明显统计学差异。比较住院期间严重心律失常、心力衰竭 ,均无明显统计学差异。 6个月心脏事件随访包括 :再次AMI、心力衰竭、复合终点事件 ,均有明显统计学差异 ;而心绞痛、心源性死亡比较 ,无明显统计学差异。结论 高血压可能为老年人冠脉造影正常AMI的主要危险因素 ;长期大量吸烟为中年人的主要诱因 ,中年人预后良好 。

Objectives To investigate the risk factors and prognosis of acute myocardial infarction patients with normal coronary angiogram. Methods Selected 22 AMI patients with normal coronary angiogram in 530 AMI patients operated coronary angiogram from July 1996 to Aug 2003 in our hospital. These patients were allotted into two groups: middle-aged(13 cases)and elderly(9 cases). A comparison was made in the context of composite risk factors and prognosis. Results In the middle-aged group, hypertension was noted in 7 cases(7/13),and 8 were heavy smokers(8/13);While in the elderly group, they were 9/9 and 3/9 respectively. The differences were statistically significant. As to hypercholesterolemia, diabetes and heavy drinking,the differences were insignificant. Incidences of in-hospital malignant arrhythmia, congestive heart failure were similar in the two groups. Six-month follow-up revealed: re-infarction,heart failure,composite end points all statistically sigrnificant. The incidences of angina pectonis, cardiac death were simialar.Conclusions In elderly AMI patients with nomal angiogram,hypertension is a possible-risk factor,in the middle-aged group heavy smok-might precipitate AMI The prognosis is fair in the middle-aged, and worse in the elerly.