冠状动脉完全闭塞无心肌梗死患者临床特点

Clinical characteristics of coronary total occlusion in patients without myocardial infarction

目的探讨冠状动脉完全闭塞无心肌梗死患者的临床特点。方法选取冠状动脉造影显示冠状动脉完全闭塞而无心肌梗死发生的23例患者(无心肌梗死组)和冠状动脉造影显示冠状动脉完全闭塞有明显临床心肌梗死证据的27例患者(心肌梗死组),比较两组患者的临床特点。结果两组在高血压、年龄、性别等方面比较差异无显著性。无心肌梗死组在糖尿病、血脂异常、吸烟、心绞痛史等方面与心肌梗死组比较,差异均有显著性(均为P<0.05)。无心肌梗死组冠状动脉病变血管支数较心肌梗死组多,侧支循环建立较好。但经皮冠状动脉介入治疗的成功率要低于心肌梗死组。结论冠状动脉造影显示有冠状动脉完全闭塞患者中,部分患者可无心肌梗死表现。除年龄、性别等不可控制因素外,糖尿病、血脂异常、吸烟等危险因素可能促进冠状动脉粥样硬化的发展。部分冠状动脉完全闭塞而无心肌梗死的患者常有较长的心绞痛史,冠状动脉病变弥散,侧支循环建立较好,所以在某支冠状动脉病变发展到完全闭塞时可不表现心肌梗死。

Objective To investigate the clinical characteristics of coronary total occlusion in the patients without myocardial infarction. Methods 23 cases diagnosed as coronary total occlusion without myocardial infarction （ non-myocardial infarction group ）, and 27 as coronary total occlusion with myocardial infarction （ myocardial group ） by angiography were included in the study for comparison of clinical characteristics between groups. Results There were few apparent differences in hyportension history, age and gender between groups, but significant differences were found in diabetes,dyslip/demia, smoking, and angina pectoris in non-myocardial infarction group as compared with those of myocardial infarction group （P 〈 0.05 for each）. More coronary blood vessels were involved and the coronary collateral circulation was well constructed in non-myocardial infarction group than in myocardial infarction group. However,non-myocardial infarction group underwent lower success rate of percutaneous coronary intervention （PCI） than myocardial infarction group. Conclusion There maybe no myocardial infarction in some patients with coronary total occlusion confirmed by angiography. The of uncontrolled factors such as age gender, some risk factors like diabetes ,dyslipidemia, and smoking can promote the development of atherosclerosis. Furthermore, some patients have long term of angina pectoris and diffuse coronary artery lesion but with well-constructed coronary collateral circulation ,so those patients will not show myocardial infarction when coronary artery lesion is developed to total occlu sion.