运动诱发ST段抬高者的冠状动脉病变特点及治疗探讨

Clinical significance of exercise-induced ST-segment elevation in patients without previous myocardial infarction

目的 :观察无心肌梗死 (MI)运动诱发心电图ST段抬高者 6例 ,探讨其冠状动脉 (冠脉 )病变特点及治疗方法。方法 :对无MI而运动诱发心电图ST段抬高的患者进行静息心电图、运动试验及冠脉造影检查 ,运动试验采用Bruce方案。结果 :在 2 86 4例行运动试验检查者中 ,有 6例未患MI而运动诱发心绞痛伴心电图ST段抬高 ,发生率为 0 .2 1%。相应导联ST段抬高 0 .1～ 1.0mV ,停止运动后心绞痛症状消失 ,ST段恢复正常。 6例中 ,1例冠脉病变轻 (狭窄 <35 % ) ,但于冠脉造影后 4周发生急性MI ,梗死部位与ST段抬高导联所对应的部位一致 ;余 5例冠脉均有严重狭窄 (90 %～ 10 0 % ) ,ST段抬高导联与缺血相关血管有良好的对应关系 ,近期内行冠脉腔内球囊成形术效果良好 ,术后症状消失 ,多次复查运动试验 ,结果均阴性。结论 :无MI患者运动诱发心电图ST段抬高多提示心肌透壁缺血 ,冠脉病变重 ,预后差 ,应采取积极的治疗措施。

Objective: To study the lesion characters of coronary artery and optimal treatment of patients without previous myocardial infarction who developed an exercise induced ST segment elevation. Method: Six patients without previous myocardial infarction who developed ST segment elevation during exercise testing were underwent coronary angiography and rest electrocardiography, and Bruce protocol were used during exercise test. Result:The incidence of exercise induced ST segment elevation was 0.21 %(6/2 864). ST segment elevated 0.1 ～ 1.0 mV in relevant leads during exercise testing. One of the 6 patients had only a mild coronary stenosis ( <35% in diameter) in left anterior descending artery, but she developed an acute myocardial infarction 4 weeks after coronary angiography. Correspondly, the leads of myocardial infarction were found the same as the leads of exercise induced ST segment elevation. The others all had severe coronary stenosis (90%～100%). There was a good correlation between leads of ST segment elevation and related ischemic artery, and percutaneous transluminal coronary angioplasty (PTCA) was safe and effective. Also, these patients showed no negative results of exercise testing after PTCA. Conclusion: The findings indicates that patients developed exercise induced ST segment elevation without no previous myocardial infarction often have severe coronary stenosis and poor prognosis, and acute coronary syndrome should be diagnosed, and PTCA is safe and effective for these patients