冠状动脉造影正常急性心肌梗死患者临床分析

Clinical Study of Normal Coronary Arteriography with Acute Myocardial Infarction

目的分析冠状动脉造影正常的急性心肌梗死(AMI)患者临床特点,探讨其发病机制、危险因素和预后。方法回顾分析了447例AMI患者冠状动脉造影(CAG)结果及临床资料,根据CAG结果分为冠状动脉正常组(A组)57例和冠状动脉异常组(B组)390例。分析2组患者冠心病的危险因素,比较2组左室射血分数(LVEF)、心脏事件发生率。结果A组年龄均小于B组,心绞痛、高血压、糖尿病、血脂异常、家族史均低于B组(均P<0.05);吸烟、大量饮酒者高于B组(P<0.01)。Logistic多变量分析发现,吸烟、大量饮酒为CAG正常AMI患者独立危险因子。住院期间,严重心律失常、心力衰竭发生情况2组比较差异无统计学意义(P>0.05);A组总心脏事件发生率明显低于B组,LVEF值大于B组(均P<0.05)。随访结果:再次AMI、心力衰竭、严重心律失常、复合终点事件比较,A组均低于B组(均P<0.05);2组心绞痛、心源性死亡比较差异无统计学意义(P>0.05)。结论冠状动脉造影正常AMI患者是高危人群;大量吸烟、饮酒是其危险因素或诱因之一;CAG正常者与CAG异常者总心血管事件预后无明显差异。

Objective To investigate the clinical characteristic,pathogenesy,risk factor and prognosis of acute myocardial infarction （AMI） with normal coronary angiograms （CAG）.Methods The results of CAG and some correlated risk factors and other clinical data in 447 patients with AMI were analyzed.According to the results of CAG the patients were divided into normal coronary artery group with 57 cases（group A） and abnormal coronary artery group 390 cases （group B）.In both groups coronary artery disease liability factors and follow-up data were recorded and compared for coronary artery disease liability factor and LVEF and heart incident rate.Results The patients in group A were younger than those in group B （P〈0.05）;In group A the patients with angina pectoris,hypertension,diabetes,dyslipidemia,family history group were fewer than that in group B （P〈0.05）.In group A of patients with smoking and heavy drinking were more than that in group B （P〈0.01）.Logistic multivariate analysis showed that smoking and heavy drinking in patients with AMI and normal coronary angiography is an independent risk factor.During hospitalization,serious arrhythmia and heart failure compared with two groups,there was no significant difference （P〈0.05）.In group A the total incidence of cardiac events was significantly lower than that in group B;In group A LVEF was larger than the value of group B （P〈0.05）.During follow-up Re-AMI,heart failure,severe arrhythmia,composite end point event compared with two groups,the group A was lower than group B （P〈0.05）;Angina,cardiac death,the difference was not statistically significant （P〈0.05）.Conclusion It is a high risk group of patients with acute myocardial infarction （AMI） with normal coronary angiograms （CAG）.It is one of risk factors or incentives multiplicity somking and drinking in short time.It is indifferent in total heart incidents between groups of acute myocardial infarction （AMI） with normal coronary angiograms （CAG） and acute myocardial infarction （AMI） with innormal coronary angiograms （CAG）.