梗塞前心绞痛对急诊冠脉再通病人心梗范围的限制作用

Effect of preinfarction angina on limiting the infarct size in patients with AMI submitted to successful coronary reperfusion

目的 :了解急性心肌梗塞前 2 4h内的心绞痛对急性心梗再灌注成功患者的心肌是否有保护作用。方法 :经静脉溶栓或 /和PTCA治疗成功的急性心梗患者 5 0例 ,根据心梗前 2 4h有无心前区疼痛分为A和B二组 ,比较两组CK峰值、QRS计分、CK峰值指数 (CK峰值 /QRS计分 ) ,分析影响心梗面积的因素。结果 :QRS计分与CK峰值呈直线相关关系 ,而与入院时间、年龄等因素无关 ;虽然冠脉的病变程度、CK峰值两组无显著差异 ,但CK峰值指数A组为 5 5 4.2± 40 1.2 ,B组为 75 0 .5± 6 0 3.3;胸痛组有降低趋势 (P =0 .15 8)。结论 :提示梗塞前心绞痛可能对心梗再灌注成功患者的心肌有一定保护作用。

Objective:To assess whether there is any protective effect to successful reperfusional myocardium in AMI by preinfarction angina, defined as chest pain occurring within 24 hours preceding infarction.Methods:Fifty patients with their first myocardial infarction treated successfully with thrombolysis or/and PTCA were included in the study. The patients were divided into two groups according to the presence(group A) or absence(group B) of preceding angina pectoris. The peak of CK, QRS scoring, index of CK peak (CK peak/QRS scoring) and the factors that may influence the size of infarcts were analysed.Results:There was a linear correlation between QRS scorings and the peak of CK(r= 0.456,P=0.001), in spite of the timing to treatment, age, and other factors . Despite no difference in the peak of CK and coronary stenosis extent between two groups, the index of CK peak in the group A showed a favorable trend (554.2±401.2 VS 750.5±603.3 , group A and group B, respectively;P=0.158), although the values did not reach statistical significance.Conclusion:Our data revealed that preinfarction angina might exert some protective effects upon the ischemic myocardium in the successfully revascularized patients with AMI.