35例冠脉造影正常的急性心肌梗死患者发病特点

Morbidity characteristics of 35 patients with acute myocardial infarction and normal coronary angiography

目的:探讨冠状动脉造影(CAG)检查正常的急性ST段抬高型心肌梗死(STEMI)患者的发病特点。方法:选择在我院行CAG的622名STEMI患者,分为CAG正常组(35例,占5.6%)和CAG异常组(587例,占94.4%),研究两组各项检查结果,临床特点,冠心病相关危险因素,以及随访情况。结果:与CAG异常组比较,CAG正常组发病年龄[(63.1±9.9)岁比(42.7±10.1)岁]显著较小,糖尿病(28.6%比8.6%)、高血压病(52.3%比25.7%)、心绞痛(72.4%比40.0%)、高脂血症(74.1%比45.7%),前壁梗死(62.9%比17.1%)比例明显较小,吸烟(42.9%比77.1%)、发病前伴有心理或生理上应激性反应的(41.9%比71.4%),下壁梗死(32.2%比80.0%)比例,心律失常发生率(27.9%比34.3%)明显增加或升高;死亡率(6.5%比2.3%)明显降低,P<0.05或<0.01。结论:冠状动脉造影正常的急性ST段抬高型心肌梗死患者并非偶见,吸烟、应激性反应是其主要危险因素,此类患者仍属高危人群,需给予高度重视。

Objective： To explore morbidity characteristics of patients with ST-segment elevation myocardial infarction （STEMI） and normal coronary angiography （CAG）. Methods： A total of 622 STEMI patients undergoing CAG in our hospital were selected and divided into normal CAG group （n= 35, occupied 5. 6% ） and abnormal CAG group （n = 587,94. 4% ）. All examination findings,clinic characteristics,related risk factors of coronary heart disease, and follow- up status were studied and compared between two groups. Results： Compared with abnormal CAG group,there were significant reductions in onset age [. （63. 1 ± 9. 9） years vs. （42. 7 ± 10. 1） years],percentages of diabetes mellitus （28. 6% vs. 8. 6% ） , hypertension （52. 3% vs. 25. 7% ） , angina pectoris （72. 4% vs. 40. 0% ） , hy-perlipidemia （74. 1% vs. 45. 7% ）,and anterior wall infarction （62. 9% vs. 7. 1% ） and significant rise in percenta-ges of smoking （42. 9% vs. 77. 1% ）,with physiological orpsychological stress responsebeforeonset （4L 9% vs.71. 4% ） ,inferior wall infarction （32. 2% vs. 80. 0% ） ,and incidence rate of arrhythmias （27. 9% vs. 34. 3% ） ; andsignificant reduction in mortality （6. 5% vs. 2. 3% ） in normal CAG group,P〈 0. 05 or 0. 01. Conclusion： Patients with acute STEMI and normal CAGare no occaional,smoking and stress response are themajor ik factors. These patients still belong to high- risk population,which calls for intensive attention.