急性心肌梗死合并束支阻滞患者行急诊冠状动脉再血管化治疗的临床疗效

Clinical efficacy of emergency coronary revascularization acute myocardial infarction with bundle branch block

目的探讨开展急诊冠脉再血管化治疗(冠状动脉支架或旁路术)对急性心肌梗死(acute myocardial infarction,AM I)合并束支传导阻滞患者治疗的临床意义。方法分析因AM I在北京大学人民医院心脏中心接受急诊冠状动脉造影并于12 h内成功进行冠状动脉支架(percutaneous coronary intervention,PC I)或冠状动脉旁路术(coronary artery bypass grafting,CABG)患者共526例,其中,PC I 481例,CABG 45例。根据冠状动脉造影前是否合并束支阻滞及束支阻滞在手术后的恢复情况,将患者分为两组:新发束支阻滞组(入院时或术前出现束支阻滞)和未确定束支阻滞组(无以前心电图参考但入院时第1次心电图已显示束支阻滞)。分别将术后束支阻滞消失的患者定义为恢复,未消失定义为未恢复,对新发束支阻滞组恢复/未恢复、未确定束支阻滞组恢复/未恢复的死亡率进行统计学分析。结果 AM I合并束支阻滞患者共81例;AM I新发生束支阻滞发生率为3.4%(18/526);新发生束支阻滞患者行手术治疗后束支阻滞恢复正常的比例为72.2%(13/18);住院期间AM I合并束支传导阻滞患者的死亡率18.51%(15/81)较不合并束支阻滞患者4.03%(18/447)高;束支阻滞未恢复患者住院期间死亡率23.08%(15/65)较未合并束支阻滞患者病死率4.03%(18/447)高;束支阻滞恢复患者的死亡率0(0/16)较未恢复患者的死亡率23.08%(15/65)低,并且合并束支阻滞患者总共死亡15例,均出现在成功再灌注后束支阻滞未恢复患者。结论 AM I新发生束支阻滞发生率低;AM I合并束支传导阻滞常常预示着高死亡率,是术后预后不良的重要预测因素;AM I合并束支传导阻滞患者可以通过急诊PC I术或CABG术使传导阻滞有所恢复,并从中获益。

Objective To explore the clinical efficacy of imergency coronary revascularization（coronary artery stenting or bypass surgery） in patients with acute myocardial infarction（AMI） patients and bundle branch block.Methods Retrospective analysis was made in 526 patients presented with AMI and received either emergency coronary angiography within 12 hours or coronary artery bypass grafting（CABG） successfully.PCI were done 481 cases and CABG in 45 cases.Patients were divided into two groups which were the group with new bundle branch block（BBB presented at admission,preoperative） and the undetermined group（patients with no previous reference but the first time of admission electrocardiogram showed bundle branch block）.The disappearance of bundle branch block was defined as recovery while the persistence of bundle branch block was defined as no recovery.Results Bundle branch block was found in 81 patients with AMI.New onset of bundle branch block occurred in 3.4% of total AMI patients（18/526）.New onset bundle branch block patients who restored to normal ECG after revascularization occurred in 72.2 %（13/18）.The in-hospital death rate was higher in patients with bundle branch block（18.51% vs.4.03%,P0.05）.The death rate was higher in patients with persistent bundle branch block than those without bundle branch block（23.08% vs.4.03%,P0.05）.There was no in-hospital death recorded in patients with recovery bundle branch block after revascularization.Conclusions The rate of new onset bundle branch block is relatively in AMI cases.AMI combined bundle branch block often indicates high mortality rates and is an important poor prognosis predictor after PCI or CABG;Patients with AMI combined with bundle branch block can benefit from emergency PCI or CABG.