急性心肌梗死患者梗死相关血管与非梗死相关血管狭窄性病变的比较

Study of the severity of coronary artery in acute myocardial infarction

目的 :比较急性心肌梗死 (AMI)患者梗死相关血管与非梗死相关血管的狭窄性病变 ,探讨AMI与血管狭窄性病变的关系。方法 :选择 35例经重组组织型纤溶酶原激活剂溶栓后 ,经临床及 3～ 4周后的冠状动脉(冠脉 )造影显示再通、同时提示为双支病变的AMI者为研究对象 ,统计梗死相关动脉 (IRA)及非梗死相关动脉(n IRA)的狭窄病变在≤ 5 0 %、>5 0 %～ 75 %、>75 %～ 99%、10 0 % 4个范围内的病变数 ,并对冠脉病变的严重性采用Goffredo建议的冠脉病变积分法进行分析。结果 :IRA≤ 5 0 %的狭窄数 (11例 ,30 .6 % )及 >5 0 %～ 75 %的狭窄数 (10例 ,2 7.8% )均显著高于n IRA在此范围的狭窄数 (3例 ,7%及 4例 ,9.3% ,P <0 .0 1) ,n IRA在 >75 %～ 99%的狭窄数 (31例 ,72 .1% )及闭塞数 (5例 ,11.6 % )明显多于IRA的狭窄数 (12例 ,33.3% ,P <0 .0 1)及闭塞数 (3例 ,8.3% ,P <0 .0 1)。n IRA的狭窄性病变范围积分也显著高于IRA的积分〔(13.2 3± 9.4 0 )∶(8.0 8±8.10 ) ,P <0 .0 5〕。结论 :严重的冠脉狭窄性病变无法预测AMI的发生。

Objective:To investigate the severity of infarct related coronary artery (IRA) stenosis in patients with acute myocardial infarction (AMI).Method: The study consisted of 35 patients with AMI. Double-vessels disease were identified by angiography. It was classified by severity of coronary stenosis of ≤50%、>50%～75%、>75%～99% and 100%. Goffredo' scoring system of the severity of coronary stenosis was used. Result: The narrowing coronary of ≤50% (11, 30.6 %) and >50%～75%(10, 27.8 %) in IRA group were more than that in non IRA group〔3,7% and 4, 9.3 %(P< 0.01 )〕;The narrowing coronary >75%～99% (31, 72.1 %)and in 100%(5, 11.6 %) in non IRA group were more than those in IRA〔12, 33.3 % and 3, 8.3 %,(P< 0.01 )〕; According the scores, the severity of coronary in non IRA group were higher than that in IRA group ( 13.23 ± 9.40 vs 8.08 ± 8.10 ,P< 0.05 ).Conclusion: The severity of coronary artery can't predetermine the development of acute myocardial infarction.