梗死前心绞痛对初发ST段抬高的急性心肌梗死的影响

Influence of preinfarction angina pectoris on patients with primary ST elevation acute myocardial infarction

目的：观察梗死前心绞痛（PAP）对初发 ST段抬高急性心肌梗死（AMI）进展的影响。方法：280例初发ST段抬高 AMI患者，发病后24h内进行冠脉造影，心电图检查并作 QRS记分。根据有无PAP，患者被分为 PAP （102例）和非PAP组（178例）。根据发病至造影时间患者被分为：早期组（＜2h，60例）、中期组（2-6h，150例）和晚期组（6-24h，70例）。结果：伴有PAP患者较无PAP患者 QRS记分显著降低[（2.4±2.4）分比（3.2±3.0）分]，PAP组高 QRS记分比例亦显著低于非 PAP组（8.0％比18.4％），P 均＜0.05。早期组，PAP与非PAP患者之间 QRS记分无显著差异[（2.0±1.8）分比（2.6±2.8）分，P＝0.35]；中期组，PAP患者QRS记分显著低于非PAP组[（2.0±2.1）分比（3.0±3.0）分，P＝0.03]；晚期组，PAP和非 PAP患者 QRS记分较中期组显著上升，但两组间比较无显著差异[（4.1±3.3）分比（5.5±2.9）分，P＝0.13]；非PAP组患者 QRS记分随着发病时间延长逐渐增加。结论：梗死前心绞痛可延迟急性心肌梗死疾病进展，扩大再灌注治疗时间窗。

Objective：To observe influence of preinfarction angina pectoris （PAP）on primary ST elevation acute myocardial infarction （AMI）.Methods：A total of 280 patients with primary ST elevation AMI received coronary angiography （CAG）within 24h after symptoms occurred,and they received ECG and QRS scoring on hospitalization. According to PAP or not,patients were divided into PAP group （n=102）and non PAP group （n=178）.According to attack to CAG time,patients were divided into early stage group （〈2h,n=60）,mid-term group （2-6h,n=150）and advanced stage group （6-24h,n=70）.Results：QRS score of PAP patients [（2.4±2.4）scores]was significantly lower than that of non PAP patients [（3.2±3.0）scores],percentage of high QRS score in PAP group （8.0%）was also significantly lower than that of non PAP group （18.4%）,P〈0.05 both.In early stage group, there was no significant difference in QRS score [（2.0±1.8）scores vs.（2.6±2.8）scores,P=0.35]between PAP and non PAP patients;The QRS score of PAP patients [（2.0±2.1）scores]was significantly lower than that of non PAP group [（3.0 ±3.0）scores]in mid-term group,P=0.03;in advanced stage group,the QRS score all significantly rose in PAP patients [（4.1 ±3.3）scores]and non PAP patients [（5.5±2.9）scores],P=0.13;QRS score gradually rose along with onset time prolonged in non PAP group.Conclusion：Preinfarction angina pectoris can delay progress of acute myocardial infarction and expand therapeutic window of reperfusion.