急性心肌梗死合并心力衰竭的临床研究

Clinical study on acute myocardial infarction complicated with heart failure

目的探讨急性心肌梗死合并心力衰竭患者临床特征及冠状动脉病变的特点。方法对150例急性心肌梗死合并心力衰竭患者的临床特征及冠脉造影(CAG)结果进行分析。结果与NSTEMI组相比:①STEMI组既往合并心肌梗死比例(2.3%/18.8%)偏小,2组差异有统计学意义(P<0.05),年龄、高血压、糖尿病、高血脂等比较无显著性差异;②STEMI组心室率、肌钙蛋白T(TnI)峰值、肌酐清除率、局部室壁运动障碍比例偏高,而收缩压及舒张压偏低,两者差异有统计学意义(P<0.05);③STEMI组TIMI0-1级比例高、狭窄程度明显,而合并3支病变、侧支循环比例偏低,两者差异有统计学意(P<0.05),2组冠脉病变类型、罪犯血管差异无统计学意义。结论非ST段抬高型急性心肌梗死合并心力衰竭患者的3支病变、侧支循环比例高于ST段抬高型急性心肌梗死组,后者罪犯血管血流灌注更差,两者具有不同的临床特点。

Objective To compare the characteristics of patients with acute myocardial in- farction complicated with heart failure and coronary artery disease. Methods Patients from January 2011 to December 2011 with acute myocardial infarction complicated with congestive heart failure were included in the study. According to whether there was ST elevation, the patients were divided into non ST segment elevation acute myocardial infarction （NSTEAMI） group and ST segment ele- vation acute myocardial infarction （STEAMI） group. The clinical features and the severity of coro- nary artery lesions of the two groups were compared. Result Compared with the NSTEMI group, （1） the ratio of the STEMI group associated with myocardial infarction （2.3 %/18.8% ） was small. The difference between the two groups was statistically significant （P 〈 0.05）. There were no sig- nificant differences in age, hypertension, diabetes, and hyperlipidemia history. （2） The proportions of cardiac troponin, TnI, creatinine clearance rate, and ventricular wall motion in the STEMI group were high, while the systolic and diastolic blood pressures were low. The differences were statisti- cally significant （ P 〈 0.05）. （3） The proportion of TIMI0 - 1 level was high, narrowness was marked, and the three coronary artery lesion and collateral circulation ratio were low in the STEMI group. There was statistical significance between the two groups （P 〈 0.05）. There were no differ- ences in the types of coronary artery lesions and culprit blood vessels between the two groups. Con- clusion The proportions of three vessel disease and coronary collateral circulation in NSTEMI pa- tients are higher than those in STEMI group. The culprit artery perfusion of the STEMI group was worse. Both of them have different clinical characteristics.