急性心肌梗死自溶现象分析──附31例报告

Analysis of spontaneous recanalization in acute myocardial infarction.

目的:分析急性心肌梗死(acutemyocardialinfarction,AMI)梗死相关动脉(infarctrelatedartery,IRA)的自溶现象,探讨自溶现象的影响因素和预后意义。方法:155例未予静脉溶栓的首次AMI患者,均在发病12小时内行直接经皮冠状动脉介入治疗(percutaneouscoronaryintervention,PCI)。所有患者按照有无自溶现象分为两组:自溶组(31例)和无自溶组(124例)。用放射性核素测定心功能,观察两组心力衰竭、再发心肌梗死的发生率和住院病死率。结果:①自溶组梗死前心绞痛的发生率显著高于无自溶组(P<0.01);CKMB、心肌肌钙蛋白I峰值均低于无自溶组(P<0.01,P<0.01),侧支循环发生率亦低于无自溶组(P<0.05);②自溶组心肌梗死面积小于无自溶组(P<0.05);左心室射血分数显著高于无自溶组;③多元Logistic回归分析结果显示,梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素(P<0.01,P<0.05)。结论:梗死前心绞痛和缺乏侧支循环是发生自溶现象的独立预测因素,而自溶现象可缩小心肌梗死面积,保护心功能,改善预后。

Objective:To study the influencing factors and prognostic value of spontaneous recanalization(SR) of infarct related artery(IRA) in acute myocardial infarction(AMI) Methods:One hundred and fifty-five patients with first AMI underwent percutaneous coronary intervention (PCI) within 12h after onset. The study population was divided into two groups according to the presence(group A,n=31) or absence (group B,n=124) of SR. Left ventricular function was assessed by radionuclide imaging.The incidence of heart failure,reinfarction and mortality in hospital were observed.Results:① Patients with SR had a significantly higher incidence of preinfarction angina(P<0.01), a significantly lower peak of CK-MB (P<0.01), a significantly lower peak of cardiac troponin I (cTnI,P<0.01) and a lower incidence of collateral circulation than those without SR(P<0.05);②Patients with SR had smaller myocardial infarction size (P<0.05) and significantly higher left ventricular ejection fraction than those without SR(P<0.01);③Multivariate logistic analysis showed that preinfarction angina and absence of collaterals were major independent determinants of SR(P<0.01,P<0.05). Conclusion:Preinfarction angina and absence of collaterals were independent determinants of SR,which is associated with smaller infarct size, better ventricular function and better outcome.