急性心肌梗死后不同时期心房颤动发生的临床机制

The study on the mechanism of acute myocardial infarction with atrial fibrillation in the different time

目的 探讨急性心肌梗死(AMI)后不同时间发生心房颤动(Af)的临床意义及机制。方法 按AMI后12h内和大于12h发生Af者,将106例有Af的AMI患者分为早期组(48例)和后期组(58例),回顾性分析急性心肌梗死后不同时期心房颤动发生者的超声心动图、冠状动脉造影(CAG),急诊经皮腔内冠动脉成形术(PTCA)和静脉溶栓的临床资料。结果 统计学显示两组的年龄(65.7±12.6岁vs 68.1±10.2岁)、左心房内径(38.1±3.26mm vs 39.O±4.35mm)无显著性差别(P>O.05)。早期组的左心室射血分数(O.58±O.12 vs O.40±O.10,P<O.05)及Killip分级心功能评定均显著优于后期组。后期组的冠状动脉三支病变(36.4%vs 16.5%,P<O.01)、前壁梗死(40.O%vs 17.6%,P<O.01)发生率均高于早期组。早期组血管再通率高达73.6%,后期组仅为16.6%(P<O.01);30天内死亡率前者为8.O%,后者为23.3%(P<0.01)。结论 AMI并发Af的早期组血管再通率高;而后期组的心功能显著降低,冠状动脉三支病变、前壁梗死的发生率及死亡率均高于早期组。说明在AMI发病后的不同时期,AMI并发Af发病的机制可能不同。

Objective To explore the clinical significance and mechanism of acute myocardial infarction with atrial fibrillation in the different time. Methods According to the occurrence of atrial fibrillation within or after 12 hour of a-cute myocardial infarction, 106 AMI patients with atrial fibrillation were divided two groups:the early onset group (48 cases) and later onset group (58 cases). The database of angiography ,UCG,emergency PTCA,venous throm-bolysis of the AMI patients with Af in the different time were retrospectively analysed. Results There was no difference in age,diameter of left atrial between two groups. However,the left ventricular ejection fraction(LVEF)and the Killip classes in the early onset group were significantly higher than those in the later onset group. The incidence of three-vessel lesions and anterior AMI in the later onset group(36. 4%,40. 0%) was significantly higher than the early onset group (16. 5%,17. 6%),P<0. 01. The early onset group exhibited a greater reperfusion rate (73. 6%) than the later onset group(16. 6%). The mortality during 30 days,the early onset group was sinificantly lower than the later onset group(8. 0% vs 23. 3% ,P<0. 01). Conclusion The early onset of Af After AMI has a higher rate of coronary artery reperfusion. The coronary multivessel lesions,poorer heart function,the incidence of anterio-infarction and the mortality have a significant association with the occurrence of the later onset of Af after AMI,and indicated that the mechanism of the early onset of Af may be different from the later onset of Af.