心电图ST段压低和无偏移型心肌梗死患者的临床特征

Clinical features in patients with ST depression and non-ST segment deviation myocardial infarction

目的:观察不同心电图ST段偏移表现的非ST段抬高型心肌梗死(NSTEMI)患者临床特征,探讨依据心电图对其进行分类的临床意义。方法:早期行冠状动脉造影检查的NSTEMI患者203例,依据心电图ST段偏移方式的不同分为:ST段压低型心肌梗死组(压低组,121例)和ST段无偏移型心肌梗死组(无偏移组,82例)。分析患者的临床特征、冠状动脉病变特点、梗死相关动脉(IRA)及其介入治疗前后TIMI血流分级、患者病死率。结果:1无偏移组患者年轻、男性多见,心肌梗死及糖尿病病史较少见。2无偏移组中单支血管病变者明显多于压低组(χ2=14.868,P=0.002),且IRA以回旋支多见;IRA TIMI 0、1级的比率低于压低组(χ2=37.516,P<0.001)。无偏移组患者IRA侧支循环TIMI 2、3级的比率高于压低组患者(χ2=12.500,P<0.001)。3无偏移组中行急诊介入治疗的患者少于压低组(χ2=18.160,P<0.001)。2组患者病死率差异无统计学意义(χ2=1.810,P=0.178)。结论:NSTEMI患者临床表现较轻,但也要选择早期冠状动脉造影检查,并积极行介入治疗。

Aim：To explore the clinical features in patients with non-ST-elevation myocardial infarction （ NSTEMI） and different electrocardiographic manifestations .Methods：A total of 203 consecutive patients with NSTEMI undergone early coronary angiography .According to the difference of ST segment deviation pattern ,the patients were divided into two groups：ST-depression group（121 cases）and non-ST-deviation group（82 cases）.The clinical characteristics,the lesion features of coronary artery,the mortality in hospital,infarction related artery（IRA）and its TIMI grades prior and after interventional therapy were analyzed.Results：（1）The young and male patients were less common for myocardial infarction and diabetes in non-ST-deviation group.（2）There were more single-vessel lesion in non-ST-deviation group（χ2 =14.868,P=0.002）, and the IRA was often the circumflex artery .The rate of total occlusion of IRA in non-ST-deviation group was lower than that in ST-depression group（χ^2 =37.516,P〈0.001）.Collateral circulation in non-ST-deviation group was better than that in ST-depression group（χ2 =12.500,P〈0.001）.（3）It was more frequent in ST-depression group without primary percutane-ous coronary intervention than non-ST-deviation group（χ^2 =18.160,P〈0.001）.The rates of death between the two groups had no significant differences （χ^2 =1.810,P=0.178）.Conclusion：There are obvious differences between ST-depression and non-ST-deviation groups in clinical characteristics ,the lesion features of coronary artery ,therapy strategy and the mortal-ity in hospital .NSTEMI patients with different ECG manifestations should be treated with PCI in time .