梗死部位对急诊经皮冠状动脉介入治疗患者预后的影响

Relationship between infarct location and prognosis after emergency percutaneous coronary inter-vention in patients with acute myocardial infarction

目的探讨急性心肌梗死（AMI）行急诊经皮冠状动脉介入（PCI）治疗后梗死部位与预后的关系。方法入选121例行急诊PCI治疗的ST段抬高心肌梗死患者，根据梗死部位分为前壁组（46例）、下壁组（53例）和下壁合并右室组（22例），分析各组临床表现、ECG、心脏彩色多普勒超声及冠状动脉造影的特点，并进行随访。结果与下壁组、下壁合并右室组相比，前壁组患者CPK同工酶-MB（CPK-MB）、心肌肌钙蛋白T升高[（387．2±45．7）U/L和（1．9±0．4）ng／L]，侧支循环形成少（4．3％），3支病变血管少（13．0％），但ST段回落差，住院期间及出院1年时病死率高；下壁合并右室组患者休克及房室传导阻滞，室性心律失常发生率高（36．4％和50．0％），3支病变血管多（45．5％），血栓形成多（86．4％），因主要心脏不良事件再住院率高。结论前壁及下壁合并右室心肌梗死是PCI治疗后患者预后差的强烈预测因子。

Objective To investigate the relationship between infarct location and prognosis after emergency percutaneous coronary intervention （PCI） treatment in patients with acute myocardial infarction.Methods Consecutive 121 patients with ST elevation myocardial itffaretion （STEMI） who underwent primary PCI were divided into 3 groups according to the infarct location. Their clinical, ECG, echocardiography and coronary anglography features were analyzed,and the follow-up was made. Results Compared with inferior wall infarction group and inferior wall infarction combined with right ventricular infarction group, anterior wall myocardial infarction group had higher CPK-MB and cTnT,less frequent collateral,reduced ST-segment resolution, higher mortality rates in hospitalization and one year after discharge . On the other hand,inferior infaretion combined with right ventricular infarction group had more occurrences of shock and atrial vetricular block or ventricular arrhythmia, more incidence of multivessel disease and thrombus, and higher readmission rate. Conclusion Patients with anterior wall myocardial infarction and inferior wall infarction combined with right ventricular myocardial infarction have poor prognosis after PCI treatment.