急性心肌梗死伴新发右束支阻滞的临床意义

The clinical characteristics and significance of new onset right bundle branch block with acute myocardial infarction

目的探讨急性心肌梗死(AMI)合并新发右束支阻滞(RBBB)的临床特征及意义。方法回顾性分析同期住院的AMI伴新发RBBB(观察组)与同期住院的无新发RBBB患者(对照组),比较两组的基线资料、心电图、冠状动脉造影(CAG)、肌钙蛋白(c TNI)滴度、血清肌酸激酶同工酶(CK-MB)峰值、心功能及院内主要不良心脏事件(MACE)。结果观察组新发RBBB多继发于急性前侧壁心肌梗死,梗死相关动脉(IRA)以左冠状动脉前降支(LAD)近端多见;观察组c TNI滴度、(CK-MB)峰值、Killip平均分级、住院期间MACE发生率均明显高于对照组,而左室射血分数(LVEF)则低于对照组。结论 AMI合并新发RBBB提示心梗面积大,病情凶险,预后不良,应尽早行再灌注治疗。

Objective To explore the clinical characteristics and the significance of new onset right bundle branch block （RBBB） in patients with acute myocardial infarction （AMI）.Methods Comparative analyses of baseline clinical characteristics,electrocardiogram （ECG）,coronary angiographic（CAG）,troponin drops（cTNI）,serum creatine kinase isoenzyme （CK-MB） peak,cardiac function and in hospital major cardiovascular events（MACE） between new onset RBBB （observation group） and non-new onset RBBB （control group） with AMI were studied retrospectively.Results Observation group （new onset RBBB） occurs secondary to acute anterior wall myocardial infarction,and proximal left anterior descending coronary artery （LAD） in infact related artery （IRA） occured more; cTNI drop,serum creatine kinase isoenzyme （CK-MB） peak,average Killip classification,incidence of MACE during hospitalization of observation group were evidently higher than that of control group,while the left ventricular ejection fraction （LVEF） is lower than that of the control group.Conclusions New onset RBBB with AMI suggests the large area,severity of disease and the poor prognosis,which should be line of reperfusion therapy as early as possible.