急性心肌梗死自溶现象及其影响因素分析

Analysis on spontaneous recanalization in acute myocardial infarction

目的分析急性心肌梗死（AMI）梗死相关血管（IRA）的自溶（SR）现象,探讨SR现象的影响因素。方法连续观察205例未予静脉溶栓治疗,直接行急诊冠状动脉造影的AMI患者,根据TIMI血流分为自溶组（前向血流TIMI 2-3级）和非自溶组（前向血流TIMI 0-1级）,分析其临床和造影特点,并寻求发生SR的影响因素。结果自溶组共49例（23.9%）。与非自溶组比较,一般临床情况差异无统计学意义（P〉0.05）,但自溶组发生梗死前心绞痛的比例较高（38.8%比22.4%,P〈0.05）。而非自溶组多支病变和存在侧支循环的比例高于自溶组（P〈0.05）。Logistic回归分析则提示多支病变和侧支循环是发生SR现象的独立影响因素。结论SR是AMI患者较常见的现象,其独立影响因素是多支病变和侧支循环。

Objective To analyse spontaneous recanalization （SR） in acute myocardial infarction （AMI） , and to identify the independent factors relating to SR. Methods Two hundred and five consecutive AMI patients without previous intravenous thrombolytic therapy received emergency coronary angiography. The study population was divided into two groups according to the presense or absence of SR, which was defined as the presense of TIMI antergrade flow no less than 2 grade on the angiogram. Clinical and angiographic features were analyzed. Results Forty - nine cases （ 23.9% ） were in SR group, and there was no significant difference about baseline clinic characteristics between the two groups. SR occurred more frequently in patients with preinfarction angina, and less in pts with multivessel disease and collaterals. Logistic regression analysis showed that multivessel disease and collaterals were independent factors of SR phenomenon. Conclusion SR is not uncommon. Multivessel disease and no collaterals were independent predictors of SR.