冠状动脉侧支循环与前驱心绞痛对急性心肌梗死的影响

The effects of collateral circulation and prodromal angina pectoris on patients with acute myocardial infarction

目的 :探讨侧支循环 (CR)和前驱心绞痛对急性心肌梗死 (AMI)患者梗死范围和心功能的影响及其可能的机制。方法 :119例首次AMI患者行选择性冠状动脉造影和左心室造影 ,分析冠状动脉CR及前驱心绞痛与AMI时肌酸激酶 (CK)峰值浓度和左室功能改变等的关系。结果 :①全组共 119例患者 ,兼有CR和前驱心绞痛者 (A组 ) 5 3例 ;有CR无前驱心绞痛者 (B组 ) 2 1例 ;仅有前驱心绞痛者 (C组 ) 2 6例 ;既无CR又无前驱心绞痛者 (D组 ) 19例。②心肌酶学改变 :A组CK峰值浓度显著低于D组 (P <0 .0 5 ) ,其CK同工酶 (CK MB)的峰值浓度显著低于D组和B组 (分别P <0 .0 1和 <0 .0 5 ) ;而且B组和C组的CK MB峰值浓度均低于D组 (均P <0 .0 5 )。③各组患者的心肌梗死部位、病变血管支数无统计学差异 ,但非Q波心肌梗死的比例A组显著高于D组(36 %对 2 1% ,P <0 .0 5 )。④心功能情况 :A组左室射血分数 (LVEF)显著高于其他各组 ,而且B组和C组的LVEF均高于D组 (P <0 .0 5 )。而室壁运动Cortina计分则A组明显低于其他各组 ,B组和C组均显著低于D组 (P <0 .0 5 )。结论 :冠状动脉CR和前驱心绞痛所致的缺血预适应对AMI患者的心肌均有重要的保护作用 。

Objective:To elucidate the synergic and independent myocardial protective effects of collateral circulation and prodromal angina pectoris (AP) on patients with acute myocardial infarction.Method: One hundred and nighteen patients with the first acute myocardial infarction underwent selective coronary angiography and left ventriculography. The relation of collateral circulation and prodromal AP to peak creatine kinase and left ventricular function were analyzed separately.Result:①In the 119 patients, there were 53 with both collateral recruitmeat and prodromal AP (group A), 21 with solely collateral recruitmeat (group B), 26 with solely prodromal AP (group C) and 19 with none of the two factors (group D). ② The peak creatine kinase was significantly lower in group A than in group D (P< 0.05 ), and the peak creatine kinase MB fraction was significantly lower in group A than in group B and D (P< 0.01 and < 0.05 , respectively). The peak creatine kinase MB fraction in group B and C was significantly lower than that in group D (P< 0.05 for both comparisons). ③The ratio of non Q wave myocardial infarction was significantly higher in group A than in group D (36% vs 21%, P< 0.05 ). ④ The left ventricular ejection fraction (LVEF) was higher, and the left ventricular wall motion cortina score was lower in group A than in the other groups (P< 0.05 or 0.01 ). The LVEF in group B and C was significantly higher than that in group D (P< 0.05 ).Conclusion:By different mechanisms, collateral circulation and prodromal angina pectoris can synergically and independently protect the cardiac function in patients with acute myocardial infarction.