冠状动脉左主干急性闭塞所致急性心肌梗死患者的临床特征及预后分析

Clinical characteristics and prognoses of patients with acute myocardial infarction caused by sudden total occlusion of left main coronary artery

目的探讨冠状动脉左主干急性闭塞所致急性心肌梗死患者的临床特点及预后情况。方法回顾性分析2017年1月至2021年12月因急性心肌梗死在北京市大兴区人民医院行急诊冠状动脉造影证实冠状动脉左主干完全闭塞的32例患者的临床资料,按照预后情况分为死亡组13例,存活组19例。比较分析两组患者的临床资料及随访情况。结果32例患者的心电图表现多样,可表现为ST段抬高心肌梗死、avR导联段抬高及广泛ST段压低。18例患者合并心源性休克。死亡组患者心功能Ⅲ级、心源性休克的比例高于存活组(P<0.05)。死亡组无侧支循环、术中出现室性心律失常及术中心肺复苏的比例高于存活组,左主干置入支架的比例低于存活组,差异均有显著性(P<0.05)。随访24个月,存活组10例出现反复心力衰竭住院治疗,4例患者因出现心绞痛择期住院行经皮冠状动脉介入治疗。结论冠状动脉左主干急性闭塞所致急性心肌梗死患者的死亡率较高,根据心电图和临床特点进行早期识别和评估,并在主动脉内球囊反搏支持下尽快行再灌注治疗可挽救部分患者的生命,但成功存活者随访的严重不良事件发生率仍较高。

Objective To explore the clinical features and prognoses of acute myocardial infarction(AMI)caused by sudden total occlusion in left main coronary artery(LMCA).Method Retrospective analysis of the clinical data of 32 patients who underwent acute myocardial infarction due to acute occlusion of the left main artery in Daxing District People’s Hospital from January 2017 to December 2021.32 patients were divided into 13 cases and 19 cases in the survival group according to their prognosis.Clinical data were analyzed and compared between the two groups.Result The proportions of hypotension,cardiac function classⅢ,cardiogenic shock of patients in the deceased group were higher than the surviving group,and more ST-segment elevation,the lead avR and extensive ST-segment depression.In deceased group most patients had cardiogenic shock,and the proportion of without collateral circulation,intraoperative ventricular arrhythmias and intraoperative CPR given were higher in the death group than in the survival group,the proportion of stents placed in the left main stem was significantly higher in the survival group.The proportion of patients with heart failure was high at telephone followup.Conclusion The morality of LMCA sudden total occlusion was significantly high.Recognition and evaluation based on ECG and clinical features early,successful PCI may be feasible to these patients of reperfusion therapy with IABP support,while the major adverse cardiovascular events(MACE)occurrence during long-term follow-up period remained high.