左旋支闭塞所致非ST—T改变急性心肌梗死的临床探讨

Clinical Analysis of Acute Myocardial Infarction without ST-T Changes after Left Circumflex Artery

目的探讨与左旋支闭塞相关的非ST—T改变急性心肌梗死的临床特点。方法回顾性分析确诊为与左旋支闭塞相关的急性心肌梗死患者100例的心电图，将其分为ST—T改变组（n=64）和非ST—T改变组（n=36），再与其冠状动脉造影结果分析比较。结果非ST—T改变组与ST—T改变组比较，肌酸磷酸激酶同工酶值较低（17．7±2．2比18．5±0．9，P〈O．01），而右优势型和均衡型伴左旋支中、远端阻塞的发生率较高（86．1％比45．3％，P〈0．01）。两组30d死亡率（417％比0％）比较，差异无统计学意义（P〉0．05）。结论与左旋支闭塞相关的急性心肌梗死伴非ST—T改变发生率相对较低，临床特点缺乏，易导致漏诊、误诊，值得临床关注。

Objective To analyze clinical findings of acute myocardial infarction （AMI） without ST-T changes after left circumflex artery occlusion. Methods Electrocardiograms from 100 patients with AMI due to left circumflex artery occlusion were analyzed retrospectively and divided into ST-T change（n=64） and no ST-T change（n=36） groups. Coronary angiographic results were compared between the two groups. Results Compared to ST-T change group, no ST-T change group had a lower creatine kinase-MB（17.7 ± 2.2 vs.18.5 ± 0.9,P〈0.01） and a higher incidence of occlusion in the middle or distal left circumflex artery with right coronary dominance or balanced coronary circulation （86.1% vs. 45.3%,P〈 0.01）. The 30-day mortality was not significantly different in the two groups （0% vs. 4.7%,P 〉0.05）. Conclusion The in- cidence of AMI without ST-T change is relatively lower after left circumflex artery occlusion. It is liable to be misdiagnosed for lack of clinical characteristics.