梗塞前心绞痛对急性心肌梗塞短期预后及侧支循环的影响

The Influence of Preinfarction angina Pectoris on the Short term Prognosis and Collateral Circulation of Acute Myocardial In- farction

目的 为探讨梗塞前心绞痛(AP)对急性心肌梗塞(AMI)的短期预后及侧支循环的影响.方法 根据AMI前有无AP发作情况进行分组.AP组(88例)及无AP组(63例),比较两组间年龄、性别、冠心病高危因素、入院时心率血压、溶栓再通情况、磷酸肌酶激酶(CK)及同功酶MB(CK-MB),左室射血分数(LVEF),严重心功能衰竭或心源性休克,严重心律失常,心脏破裂及死亡率,用冠脉造影诊断冠脉病变,侧支循环,室壁瘤情况.结果 AP组年龄较大,两组间差异有显著性,P<0.01.冠心病高危因素两组间差异无显著性,P>0.05,AP组溶栓再通率较高,CK及CK-MB峰值较低,左室功能(LVEF)保存较好,严重心律失常及心脏破裂发生率较少,AMI死亡率降低,两组间有显著意义,P<0.05,提示AP组临床短期预后较好.冠脉造影示AP组三支病变发生率高,侧支循环丰富,无AP组以单支病变多见,两组间有显著意义,P<0.05.结论 AMI前的AP发作,提示临床短期预后较好,可能部分与侧支循环丰富有关.

objective to explore the influence of Pre-infarction angina pectoris (AP) on the short-term prognosis an collateral circulation of acute myocardial infarction (AMI). Methods Based on presence or absence of pre-infarction. AP group(88pts)and non-AP group (63pts). The ages , sex, risk factor of coronary heart disease (a + D) , heart rates and blood pressure at admission, reperfusion after thrombolytic therapy, Creatine Kinase (CK) and its isoenzyme (CK-MB),Left Ventricular ejection fraction (LVEF),severe arrhythmias, cardiac rupture and mortality rates were compared between the 2 groups. The Coronary Lesions,collateral circulation and ventricular aneurysm were diagnosed by coronary angiography (CA). Results The ages of AP-Group were older than that of non-AP group(P<0. 01). There is no difference on risk factors of CHD Between 2 groups. In AP Group,reperfusion rates and LVEF were higher,the peak value of CK and CK-MB,the rates of sveere arrhythmias and cardiac rupture,mortality rates of AMI were lower than that in non-AP group(P<0. 05). These suggested that the short-term prognosis is better in AP group than in non-AP group. CA displayed that the rates of maltivessel disease and collateral circulation are much more in AP group,otherwise,monovessel diseases are more in non-AP group. There is a significauity difference between 2 groups(P<0. 05). Conclusion:Pre-infarction AP suggested a good short-term prognosis. It may be partly related to the rich collateral circulation.