ST段抬高性和非ST段抬高性心肌梗死临床特征和冠状动脉病变特点比较

THE ANALYSIS ON CLINICAL FEATURES AND CORONARY LESION IN PATIENTS WITH ACUTE ST ELEVATION MYOCARDIAL INFARCTION AND NON-ST ELEVATION MYOCARDIAL INFARCTION

目的分析ST段抬高急性心肌梗死(STEMI)和非ST段抬高急性心肌梗死(NSTEMI)临床特征和冠脉病变特点。方法对STEMI组125例和NSTEMI组42例患者冠心病危险因素、冠心病史、平时心绞痛症状、入院时临床表现、心肌损害指标、心脏超声和冠脉造影进行比较。结果STEMI组发病年龄及合并糖尿病比例、冠心病史和平时心绞痛症状发生率均低于NSTEMI组(P分别<0.05、0.05、0.05和0.01),而吸烟、持续性胸痛及并发恶性心律失常的比例高于NSTEMI组(P分别<0.05、0.01和0.05);STEMI组肌酸激酶同工酶及肌钙蛋白I水平均明显高于NSTEMI组(P均<0.01);STEMI组冠脉单支病变明显多于NSTEMI组(P<0.01),3支病变低于NSTEMI组(P<0.05),狭窄程度<70%及70%～90%者比例低于NSTEMI组(P分别<0.05和0.01),狭窄程度>90%及完全闭塞者明显高于NSTEMI组(P均<0.05);STEMI组形成侧支循环及具有基础TIMI血流3级比例明显低于NSTEMI组(P分别<0.01和0.05);超声心动图检查指标二组差异无统计学意义(P>0.05)。结论NSTEMI患者发病年龄大,合并糖尿病比例相对较高,冠心病史长,平时多有心绞痛症状,心肌梗死时胸痛症状较轻,并发恶性心律失常的比例以及血中心肌损伤标记物较低,冠脉病变弥漫、累及多支,但阻塞程度相对较轻,有基础TIMI血流3级及形成侧支循环的比例高。

Objective To analyze the relationship between clinical features and coronary lesion in patients with acute ST elevation myocardial infarction （STEMI） and acute non- ST elevation myocardial infarction （NSTEMI）. Methods The coronary heart disease （CHD） risk factors, CHD history, angina symptom,clinical manifestation when admitted to hospital, myocardial marker, echocardiography and coronary angiography （CAG） of 125 cases with STEMI and 42 cases with NSTEMI were compard and analyzed. Results Age,the incidence rate of diabetes history, CHD history,angina symptom were lower in STEMI group than that in NSTEMI group （P〈0. 05,0. 05,0. 05 and 0.01 respectively）. The rate of smoking, continuous chest pain and malignant arrhythmia were higher in STEMI group than that in NSTEMI group （P〈0.05,0. 01 and 0. 05 respectively）. CK- MB and troponin Ⅰ were higher in STEMI group than that in NSTEMI group （P〈0.01）. 1 - vessel lesion was higher and 3 - vessel lesion was less in STEMI group than that in NSTEMI group （P〈0.01 and 0.05 respectively）. Occurrence of stenosis less than 70% and 70%-90% were lower, stenosis more than 90%and total occlusion were higher in STEMI group than that in NSTEMI group （P〈0. 05,0. 01, 0.05 and 0.05 respectively）. Collateral circulation formation and TIMI grade 3 were less seen in STEMI group than that in NSTEMI group （P〈0.01 and 0.05 respectively）. Conclusion The age of patients with NSTEMI is older,the incidence rate of diabetes is higher and CHD history is longer,angina symptoms are more common and chest pain is slighter after myocardial infarction. The incidence rate of complication with malignant arrhythmia and the concentration of CK - MB and troponin Ⅰ are lower in patients with NSTEMI than that in patients with STEMI. Coronary lesion is more diffuse but stenosis is slighter in patients with NSTEMI than that in patients with STEMI. TIMI grade 3 and collateral circulation formation are more seen in patients with NSTEMI than that in patients with STEMI.