急性心肌梗死急诊冠状动脉造影正常患者临床分析

Clinical study of acute myocardial infarction with normal coronary artery at acute phase angiogram

目的 :对比观察急性心肌梗死 ( AMI)急诊冠状动脉 (冠脉 )造影正常和异常患者的临床表现。方法 :94例 AMI患者行即刻经皮腔内冠脉成形术 ( PTCA)或溶栓治疗 ,溶栓者于溶栓开始后 90 m in行冠脉造影 ,梗死相关动脉 ( IRA)再通且无冠脉病变者为冠脉正常组 ,再通且并冠脉病变者及 PTCA成功者为冠脉异常组。记录两组患者冠心病易患因素 ,观察 ST段抬高总和 90 m in回落程度 ,比较两组患者住院期心脏事件发生率 ,并于出院前行超声心动图检查。结果 :94例患者中冠脉正常组 2 1例 ,冠脉异常组 73例。前者较后者年龄轻 ,男性、吸烟等诱因多见 ,且造影时 TIMI 3级多见 ;ST段抬高总和 90 m in回落大 ( P <0 .0 5 ) ;住院期间心脏事件发生率明显降低 ( P<0 .0 5 ) ;出院前超声心动图显示左室射血分数较大 ( P<0 .0 5 )。结论 :AMI急诊冠脉造影正常患者相对年轻 ,吸烟等诱因多见 。

Objective:To observe presentation of acute myocardial infarction (AMI) with normal coronary artery at acute phase angiogram.Method:From December 1995 to August 1998, 94 patients with AMI underwnet primary coronary angioplasty or thrombolytic theropy. In those with thrombolysis, the coronary angiography was performed 90 min after the start of thrombolytic agent application.According to coronary angiogram the patients were divided to group A(those with normal coronary artery)and group B(those with abnormal coronary artery).Result:There were 21 cases in group A and 73 cases in group B. The group A had more males, more smokers, and more cases with TIMI 3 flow in angiogram than group B. Compared with group B, the group A had much significant restoration of total elevation of ST segment at 90 min (62% vs 44%, respectively, P< 0.05 ), and few cardiac events( 4.8 % vs 12.7 %, respectively, P< 0.05 ) during hospitalization. Before discharge echocardiography showed better left ventricular ejection fraction in group A than that in group B 〔( 0.58 ± 0.09 ) vs ( 0.52 ± 0.10 ) respectively, P< 0.05 〕.Conclusion:Patients of AMI with normal coronary artery are relative younger and have more males, more inducement, and better cardiac function and clinical outcome during hospitalization.