心电图正常的急性心肌梗塞造影结果分析

Analysis of coronary angiography in acute myocardial infarction with normal electrocardiogram

目的分析心电图表现正常的急性心肌梗塞患者的冠状动脉造影特征。方法回顾2005年7月至2008年8月急性心肌梗塞患者的临床资料,其中52例心电图表现正常,通过冠状动脉造影明确诊断,分析其造影结果和临床特征。结果52例患者中,31例梗死相关血管为回旋支,这些患者的冠状动脉呈右优势型分布,回旋支血管较细小,直径介于2.23～2.87mm之间,平均2.63mm。其中17例就诊时心电图在侧壁或后壁导联ST段有抬高趋势,但达不到0.1mV;9例梗死相关血管为前降支或右冠状动脉,均已自发再通,血流达到TIMI3级;12例梗死相关血管无法判断,呈弥漫多支病变,可见多处狭窄、闭塞及侧支循环形成。30例患者急诊行PCI治疗,平均就诊-球囊扩张时间大于6h。结论回旋支闭塞是心电图正常的急性心肌梗塞最常见原因,调整目前侧后壁导联ST段抬高标准可能有助于提高心电图对回旋支闭塞的敏感性。

【Objective】 To analyze the features of coronary angiography in acute myocardial infarction（AMI） with normal electrocardiogram.【Methods】 Retrospectively analyzed the clinical data of all patients with AMI from Jul.2005 to Aug.2008.Among whom 52 cases with normal electrocardiogram were confirmed by emergency coronary angiography.Their clinical and angiographic characteristics were studied.【Results】 The infarct-related artery（IRA） is left circumflex in 31 cases,in which coronary artery were right-dominant,left circumflex were small,with diameter ranging from 2.23 mm to 2.87 mm and mean diameter 2.63 mm.Among whom,17 cases had ST segment elevation tendency on the lateral wall or posterior wall leads in electrocardiogram at admission,but did not reach 0.1 mV;IRA were left anterior descending or right coronary artery with spontaneous reperfusion in 9 cases,with TIMI Grade 3;IRA were unconfirmed in 12 cases,with diffuse multiple branch lesions,multiple stenosis,occlusions and collateral vessel formation.The mean time of door-balloon exceeded 6 hours in 30 patients receiving primary PCI.【Conclusion】 The left circumflex occlusion is the most common cause of AMI with normal electrocardiogram.Readjusting the threshold for a ＇diagnostic＇ST-segment elevation for lateroposterior wall myocardial infarction may be helpful in enhancing the diagnostic sensitivity of electrocardiogram to left circumflex occlusion.