急性下壁心肌梗死130例左前分支传导阻滞的冠状动脉造影

Coronary angiography in inferior wall acute myocardial infarction complicated with left anterior hemiblock

目的：探讨急性下壁心肌梗死发生左前分支传导阻滞与梗死相关血管关系的临床意义。方法：将１３０例急性下壁心肌梗死病人依心电图变化分两组：Ａ组２４例发生左前分支传导阻滞，Ｂ组１０６例未发生之，所有患者在发生心肌梗死３周内行冠状动脉造影。结果：前室间支冠状动脉狭窄者，Ａ组占９２％（２２／２４），Ｂ组占３３％（３５／１０６），Ｐ＝０．０００４；Ａ组２支至３支冠状动脉病变例数明显多于Ｂ组（９２％比４５％，Ｐ＝０．０００６），经线性相关分析，急性下壁心肌梗死发生左前分支传导阻滞与前室门支狭窄最相关（ｒ＝０．４６９８，Ｐ＝０．０００１），次之为左冠状动脉（ｒ＝０．２８７１７，Ｐ＝０．０００９）。结论：急性下壁心肌梗死发生左前分支传导阻滞是前空间文明显狭窄又多支冠状动脉病变或上冠状动脉病变的一个信号。

Objective: To investigate the relationship between in inferior wall acute myocardial infarction (IAMI) complicated with left anterior hemiblock (LAH) and the location of thrombosis in coronary arteries. Methods:130 patients with IAMI were divided into two groups according to electrocariogram: group A, 24 patients with left anterior hemiblock; group B, 106 patients without LAH. All patients underwent coronary angiography within 3 weeks of AMI. Results: 92% (22/24) of patients in group A had significant stenosis of left anterior descending (LAD) artery and only 33% (35/106) in group B (P=0.0004). The prevalence of two or three-vessel involvement in group. A was 92% and only 45% in group B (P=0.0006). By linear correlation analysis, development of LAH was found to be closely associated with LAD artery stenosis (r=0.4698, P=0.0001) and to left main coronary artery stenosis (r=0.28717, P=0.0009). Conclusion: Development of LAH during IAMI is a sign of significant stenosis in the LAD or left main coro- nary artery, or a sign of multiple-vessels involvement.