血栓栓塞导致急性心肌梗死的临床研究

Clinical analysis of acute myocardial infarction caused by coronary embolism

目的探讨血栓栓塞导致急性心肌梗死的临床特点及预后。方法回顾性分析8例血栓脱落至冠状动脉致急性心肌梗死患者的临床资料,并进行随访。随访内容包括死亡、再次心肌梗死、严重出血、其余部位栓塞事件及国际标准化比值(INR)达标情况。结果患者年龄(63±15)岁。5例为风湿性心脏病换瓣术后患者,1例为肥厚型心肌病患者,2例为扩张型心肌病患者。患者心电图均表现为急性ST段抬高性心肌梗死,其中前壁心肌梗死6例,下壁心肌梗死2例。7例合并心房颤动(87.5%,7/8)。所有患者行急诊冠状动脉造影可见冠状动脉栓塞,其中5例行血栓抽吸术,3例行血栓抽吸及球囊扩张术。院内随访期间,发生大面积脑栓塞死亡1例,国际标准化比值达标率87.5%(6/7),其余患者未再出现栓塞及严重出血事件。结论血栓栓塞导致心肌梗死发生于血栓形成高危人群,均表现为急性ST段抬高性心肌梗死,急性期使用血栓抽吸术尽早开通冠状动脉,术后予以规范的抗栓治疗,患者预后良好。

Objectives To explore the clinical characteristics and outcomes of acute myocardial infarction caused by coronary embolism. Methods Data of 8 patients with acute myocardial infarction caused by coronary embolism were analyzed retrospectively. The follow-up included death, recurrent myocardial infarction, serious bleeding, arterial embolism involving other organs and international normalized ratio （INR）. Results The patients were （ 63 ±15 ） years old. There were 5 patients undergone mechanical valve replacement, 1 patient with hypertrophic cardiomyopathy, and the other 2 patients with dilated cardiomyopathy. Seven of them were complicated with atrial fibrillation （87.5%, 7/8 ）. Electrocardiography （ECG） showed acute ST-elevated myocardial infarction in all patients. Among them, anterior wall infarction appeared in 6 patients and inferior wall infarction in 2 patients. Coronary embolism was found in all patients undergone primary coronary angioplasty. Five of them underwent aspiration thrombectomy, and the other 3 patients underwent aspiration thrombectomy plus balloon dilatation. During the follow-up, 1 patient died of cerebral infarction in hospital, but there were no serious bleeding and arterial embolism in other patients. The INR was controlled to 2-3 in 87.5% （6/7） patients. Conclusions Acute ST-elevated myocardial infarction due to coronary embolism can occur in patients with risk factors for thrombosis. The outcome of patients after aspiration thrombectomy and proper antithrombotic therapy is favorable.