急性前壁心肌梗死合并完全右束支传导阻滞的冠状动脉造影与临床预后分析

Relation between prognosis of complete right bundle branch block of patients with acute anterior myocardial infarction and coronary angiographic findings

目的探讨急性前壁心肌梗死(AAMI)合并完全右束支传导阻滞(CRBBB)的冠状动脉病变与临床预后的关系。方法对450例首次AAMI患者的初始心电图和冠状动脉造影与临床资料进行对比分析。结果75例(16.7%)合并有CRBBB;合并有CRBBB的患者较无CRBBB的患者年龄偏大(66.0±15.0)岁vs(59.0±10.0)岁(P<0.01),有梗死前心绞痛症状的较少(25.3%vs 52.0%,P<0.01)、完全前降支闭塞率高(81.3%vs 36.0%,P<0.01)、多支血管病变率高(40.0%vs 26.1%,P<0.01)、30天病死率高(13.3%vs 1.6%,P<0.01)。多元回归显示合并有CRBBB(OR 5.91,P<0.01)和多支血管病变(OR 4.36,P<0.01)是30天病死率的独立危险因素。结论AAMI合并CRBBB冠状动脉病变严重、虽经介入治疗临床预后仍较差。

Objective To investigate the relation between angiographic findings and prognosis of complete right bundle branch block（CRBBB） in patients with acute anterior myocardial infarction（AAMI）. Methods A total of 450 patients with first AAMI who underwent coronary angiography were enrolled. Electrocardiogram and clinical materials recorded on admission were compared and analyzed. Results CRBBB was documented on admission in 75 patients. The patients with CRBBB were older, （66.0i15.0） years old vs （59.0±10.0） years old（ P 〈0.01） ,prodromal angina less frequently （25.3% vs 52.0%, P 〈0.01）, higher occluded left anterior descending artery（81.3% vs 36.0%, P 0.01） ,more frequently multivessel lesions （40.0% vs 26.1%, P d0.01） ,and higher 30-day mortality rate（13.3% vs 1.6%, P d0.01） than in those without. Multiple logistic-regression analysis demonstrated that CRBBB （odds ratio 5.91, P d0.01） and multivessel lesions （odds ratio 4.36, P 〈 0.01） were independent predictors of 30-day mortality. Conclusion CRBBB in patients with AAMI is severe angiographic condition and has still poor prognosis even after percutaneous coronary intervention.