急性心肌梗塞合并心房纤颤的冠状动脉血管病变分析

The analysis of coronary artery lesion in the acute myocardial infarction with atrial fibrillation

目的通过分析急性心肌梗塞并发心房纤颤患者的冠状动脉病变的特点，探讨冠脉病变的不同程度对急性心肌梗塞时房颤发生的影响。方法回顾性分析了急性心肌梗塞并发房颤的患者（８７例），与同期无房颤发生的心肌梗塞患者（６００例）的冠状动脉造影、急诊ＰＴＣＡ和静脉溶栓的临床资料。结果两组患者的梗塞相关血管发生的部位差别无显著性。而三支血管病变的发生率房颤组（３１．４％）显著高于非房颤组（１８．８％）；梗塞相关血管的再通率非房颤组（６９．６％）显著高于房颤组，在房颤组中，早期组的冠脉再通率（７３．６％）又显著高于后期组（１６．６％）。结论冠脉血管的多支病变和灌注不良与急性心肌梗塞后房颤的发生密切相关。急性心肌梗塞后早期发生房颤者冠脉血管再通率高，提示ＡＭＩ发病后早期房颤的发生可能与再灌注损伤有关。

Objective To explore the effects of the difference of coronary lesions on the occurrence of atrial fibrillation (AF) in acutemyocardial infarction (AMI) by analysing the characteristics of coronary artery lesions in the acute myocardial infarction patient with atrial fibrillationWT5HZMethods We retrospectly analyse the database of angiographyemergency PTCAvenous thrombolysis of the AMI patients with AF (87) and AMI patients without AF Results There was no difference in the locations of the infarctrelated vassels between two groupsHowever,the incidence of threevassel lesions in the AF group (314%) was significantly higher than the nonAF group (188%)In the AF group,the early onset subgroup exhibited a greater reperfusion rate (736%) than the later onset subgroup Conclusion The coronary multivassel lesions and poorer reperfusion have a significant association with the occurrence of the AF after AMIThe early onset of AF after AMI has a higher rate of coronary artery reperfusion,indicated that the early onset of AF may relate to the reperfusing injury