冠状动脉造影正常的ST段抬高胸痛患者病因分析

Analysis of 21 patients with chest pain accompanied by ST-segment elevation and normal coronary angiography

目的探索冠脉造影正常的急性ST段抬高胸痛患者的病因。方法回顾并分析2015~2019年在北京安贞医院急诊就诊21例冠脉造影正常的ST段抬高胸痛患者临床资料和影像学结果,包括临床症状、心电图检查、超声心动图检查、冠状动脉造影结果,肌钙蛋白I(cTnI)水平。结果21例患者就诊时症状均为胸痛,急诊心电图均显示ST段抬高,最终诊断早复极综合征3例,急性心肌炎3例,应激性心肌病4例,变异性心绞痛5例,急性心肌梗死6例。急性心肌梗死患者cTnI水平明显高于其它患者。结论ST段抬高胸痛患者病因除急性心肌梗死外,也包括急性心肌炎、应激性心肌病、变异性心绞痛及早复极综合征。

Objective To explore the pathogeny of chest pain of normal coronary angiography in patients with ST segment elevation.Methods Review the clinical data and imaging results data of 21 patients with ST-segment elevation chest pain with normal coronary angiography who visited the emergency department of Beijing Anzhen hospital from 2015 to 2019,including clinical symptoms,electrocardiogram,echocardiography,coronary angiography results,troponin I(cTnI)level.Results All the 21 patients presented with chest pain,and the emergency electrocardiogram showed ST-segment elevation.The final diagnosis was 3 cases of early repolarization syndrome,3 cases of acute myocarditis,4 cases of stress cardiomyopathy,5 cases of variant angina pectoris,6 cases of acute myocardial infarction.The level of cTnI in patients with acute myocardial infarction was significantly higher than that of other patients.Conclusion The etiology of ST-segment elevation chest pain with normal coronary angiography in addition to the myocardial infarction,also includes acute myocarditis,stress cardiomyopathy,variant angina pectoris and early bipolar syndrome.