心肌梗死后不同时期内梗死相关动脉病变情况分析

The Characteristics of Lesion of Infarct-related Artery at Different Stages After Acute Myocardial Infarction in Patients

目的总结分析心肌梗死后不同阶段患者的梗死相关动脉的闭塞情况。方法回顾性分析自2005年6月至2011年6月在我科住院行选择性冠状动脉造影的心肌梗死患者1 524例的临床资料,根据患者行冠状动脉造影的时间和心肌梗死类型将所有的患者分为4组:24 h内急诊冠状动脉造影的ST段抬高型急性心肌梗死组(急诊CAG STEMI组)、7天至2周内行择期冠状动脉造影的ST段抬高型急性心肌梗死组(择期CAG STEMI组)、陈旧性心肌梗死组(OMI组)、3天内行冠状动脉造影的非ST段抬高型急性心肌梗死组(NSTEMI组)。通过分析各组的影像学资料,观察梗死相关动脉分布和闭塞情况。结果各组梗死相关动脉的分布情况为:急诊CAG STEMI组中,左前降支的发生率明显高于其他梗死相关动脉;择期CAG STEMI组中,左前降支和右冠状动脉仍高于其余梗死相关动脉;OMI组中,各梗死相关动脉无明显差别;NSTEMI组中,左前降支和左回旋支高于其余动脉。各组梗死相关动脉的闭塞情况为:急诊CAG STEMI组高于择期CAG STEMI组、OMI组、NSTEMI组(P<0.001),OMI组高于择期CAG STEMI组、NSTEMI组(P<0.01),择期CAG STEMI组与NSTEMI组比较差异无显著性。结论梗死相关动脉为左回旋支时常不能及时发现就诊,需要提高对梗死相关动脉为回旋支的心肌梗死患者的识别和及时治疗。ST段抬高型急性心肌梗死患者1～2周后闭塞率明显降低,近一半的患者达到TIMI 2～3级血流。非ST段抬高型急性心肌梗死患者梗死相关动脉的闭塞率较低,可能是无ST段抬高的原因之一。

Aim To investigate the characteristics of lesion of infarct-related artery（IRA） at different stages after acute myocardial infarction.Methods The data of 1 524 patients with myocardial infarction（MI） who underwent coronary angiography（CAG） from June 2005 to June 2011 were retrospectively analyzed.All the patients were divided into four groups according to the time between onset and CAG： Group A： patients with ST-segment elevation MI（STEMI） who received emergency CAG within 24 hours;Group B： patients who received selective CAG between 1 and 2 weeks after the onset of STEMI;Group C： patients with old myocardial infarction;Group D： patients who received CAG within 3 days after the onset of non-ST-segment elevation MI（NSTEMI）.The incidences of total occlusion of IRA in all groups were investigated and calculated.Results The incidence of total occlusion of IRA in group A（82.9%,651/785） was significantly higher than group B（56.4%,185/328）,group C（72.7%,125/172）,and group D（55.2%,132/239）（P0.001）.There were also significant differences between group C and group B,D（P0.01）.Conclusions The incidence of total occlusions of IRA decreased sharply in two weeks after acute myocardial infarction（AMI）,and almost half of the patients achieved blood flow of TIMI（thrombolysis in myocardial infarction） grade 2 to 3 in IRA.A low rate of total occlusion of IRA was found in the patients with NSTEMI,which may account for non-ST-segment elevation.