冠心病患者残余心肌缺血的早期识别

The identification of residual myocardial ischemia in the early stage of myocardial infarction

目的 探讨冠心病患者残余心肌缺血 (RI)的早期诊断方法。方法 经冠状动脉造影 (CAG)证实存在 RI的 82 3例患者均在 CAG前后 2周内行心电图 (ECG)、运动试验 (ET)、同位素心肌扫描和动态心电图检查 ,并进行平均 1年的随访。按文献报道方法将临床常用 7种检查的 2 6个指标与 CAG的 4个指标作变量逐一量化评分 ,进行非条件 L ogistic回归、逐步判别和判别分析。结果 1心肌梗死 (MI)后心绞痛、静息心电图 ST段下移、次极量运动试验阳性、同位素可逆行心肌灌注缺损及 CAG有多支病变、次全闭塞者提示心脏事件发生率极高 ,证实对 RI的早期诊断有重要价值 ;2 RI程度对预测 MI患者的预后有重要意义。结论 ECG或 ET示 ST段下移明显 ,冠脉三支病变 ,侧支循环差者为 RI的特征表现 ,应积极处理。

Objective To select a quantitive method for identifying residual myocardial ischemia(RI) in the early stage of myocardial infarction(MI).Methods 823 patients with RI confirmed by coronary angiography(CAG) examined by electrocardiopraphy (ECG),exercise testing(ET) and ambulatory electrocardiography (AECG) in 2 weeks before and after CAG,and these tests were repeated at 3 and 6 months after CAG respectively.26 indices of 7 noninvasive tests and 4 indices of CAG were quantitatively scored for multivariable analysis.Results ST-depressions in both ET,rest ECG,the severities of angina pectoris and rest ECG serial scores was good and the predictive value of the equation concordanted with 98.5% of the primary data.9 of 26 variables were found to be powerful in predicting the prognosis of MI patients by stepwise discriminant analysis,they were the rest ECG serial scores,coronary lesion severities scores,severity of angina pectoris,coronary collateral circulation scores and ST-depressions in both ET and rest ECG.Conclusion The discriminant equations had a high value in predicting the prognosis for MI patients with an accuracy of 100% in subgroup of asymptomatic post-infarction angina and congestive heart failure,and an accuracy of 83.33%,85.71% in predicting subgroup of re-infarction and cardiac death respectively.