冠状动脉造影正常的心肌梗死患者的病因分析

Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries

目的 探讨冠状动脉造影正常患者心肌梗死病因。方法 对我院近 10年因心肌梗死而行冠状动脉造影检查的 12 0 0例患者中有 4 0例 (3 3% )造影正常并行血管内超声检查 ,回顾分析其可能的病因 ,并进行定期 (门诊和电话询问 )随诊观察临床预后。结果 4 0例心肌梗死患者中 2 9例患者由于冠状动脉痉挛所致 ,4例患者为结缔组织病 ,1例冠状动脉畸形 ,6例冠状动脉肌桥。所有患者随诊 (2 5± 17)个月 ,无主要心脏事件发生。结论 心肌梗死的病因中部分患者为冠状动脉痉挛、血管炎 ,冠状动脉畸形或肌桥等其他病因所致 ,这些患者预后良好。

Objective To analysis the etiology of patients who suffered myocardial infarction with abs olutely normal epicardial coronary arteries at the post-myocardial infarction c oronary angiogram. The clinical outcomes were also evaluated. Methods Forty patients (9 females/31 males; mean age 43.27±5.8 years, range 27～52 years) admitted with myocardial infarction had absolutely normal coronar y arteries, defined by smooth contours and no focal reduction. Infarcted arterie s were also examined by intravascular ultrasound. Results In this study, coronary spasm was found in 29 cases, collagen tissue disorders in 4 cases, congenital coronary artery malformation in 1 case, myocardial bridge in 6 cases. But IVUS examinations founded that 5 infarcted arteries had endothelial hyperplasia and 8 infarcted arteries had slight soft plague. The mean follow-u p was 25±17 months. Event-free survival, with the combined end-point defined as death, re-infarction, heart failure and stroke was 100%. Conclusion Eetialogical factors, predominantly coronary spasm and myocardial bri dge, can be detected in those patients with myocardial infarction and absolutely normal coronary angiograms. Event-survival rate is high in myocardial infarcti on patients with absolutely normal coronary angiography.