冠状动脉正常的急性Q波性心肌梗死单中心回顾性分析

Single-center retrospective analysis of acute transmural myocardial infarction with normal coronary arteries

目的回顾性分析冠状动脉正常的急性Q波性心肌梗死患者的临床特点。方法选取中山大学孙逸仙纪念医院确诊为急性心肌梗死,合并心电图病理性Q波形成,并经冠状动脉造影证实冠状动脉正常的患者17例,分析其临床特点。结果本研究中,4例患者有自发性冠状动脉痉挛,表现为冠状动脉造影时严重狭窄但冠状动脉内给予硝酸甘油后狭窄消失。1例女性患者既往有下肢动脉栓塞病史,经血液系统进一步检查证实为蛋白C缺乏症。1例患者为粒细胞增多症,3例患者为血小板增多症。另有1例患者有肺癌病史,考虑可能与肺癌相关的高凝状态有关。急性Q波性心肌梗死但罪犯冠状动脉正常的患者占同期急性心肌梗死患者比例为1.85%(17/918)。此类患者平均年龄为44.2岁,男性为主,占88.2%(15/17),吸烟比例高达82.4%(14/17),其中吸烟患者中男性达92.9%(13/14),与非冠状动脉正常的急性Q波性心肌梗死患者比较,差异有统计学意义(P<0.01)。急性Q波性心肌梗死但罪犯冠状动脉正常的患者左心室射血分数显著高于冠状动脉造影异常组(54.4%±9.6%vs.45.8%±8.8%,P<0.01)。另外,造影正常组所有患者住院期间均未发生主要心血管事件,而造影异常组主要心血管事件发生率为6.7%(60/901)。结论急性心肌梗死但冠状动脉正常患者以男性为主,多有吸烟史,同时合并有血液系统疾病者较多见,但大部分心功能状态良好,住院期间未见严重主要心血管事件。

Objectives To describe our experience with patients who had aute transmural myocardial infarction （MI） with normal coronary arteries.Their clinical profiles,demographic characteristics and outcomes are discussed.Methods A retrospectively analysis of 17 patients who had acute Q-wave MI with normal coronary arteries by coronary angiography in Sun Yat-sen Memorial Hospital was conducted.Results In this study,4 patients had spontaneous coronary spasm shown during coronary angiography,which disappeared after intracoronary injection of nitrates.Protein C deficiency,was found in 1 patient who had a history of arterial thrombosis in the lower limb.One patient had granulocytosis and three patients had thrombocythemia.One patient had a history of lung cancer,which may be associated with the hypercoagulable state.The prevalence rate of acute Q-wave MI patients with normal coronary arteries was 1.85% （17 out of 918 acute MI patients）.These patients were characterized by their young age （mean age=44.2 years）,male dominance （88.2%,15/17）,and a high prevalence of smoking （82.4%,14/17） with 92.9% male （13/14）.There were significant differences in these parameters between normal coronary arteries group and abnormal coronary arteries group （P〈0.01）.Left ventricular ejection fraction in normal coronary arteries group was much higher than that in abnormal coronary arteries group （54.4%±9.6% vs.45.8%±8.8%,P〈0.01）.In addition,no in-hospital major adverse cardiovascular event （MACE）was observed in the patients with normal coronary arteries,but 6.7% （60/901） patients had MACE in abnormal coronary arteries group.Conclusions Acute Q-wave MI with normal coronary arteries mainly occurs in young and male population,and most of them have smoking habits or a history of hematologic disorders.Few patients has severe heart failure and MACE.