心肌桥引发急性心肌梗死和再梗死

Acute myocardial infarction and re-infarction associated with myocardial bridging: two cases report

冠状动脉心肌桥可引起急性心肌梗死,而心肌桥引发急性心肌梗死和再梗死尚未见报导。我们报告2例心肌桥引起急性心肌梗死、直接冠状动脉介入(PCI)术后又引发再梗死的病例。2例患者均为急性前壁心肌梗死,直接PCI术后冠状动脉再通,但冠状动脉慢血流,TIMI血流Ⅱ级,术后患者突发剧烈胸痛,伴ST段再次抬高,符合再梗死诊断,而冠脉造影无支架内或冠状动脉内血栓形成,支架远端明显心肌桥,收缩期压迫为85%～90%。可能机制为:由于心肌桥的压迫或痉挛,使再通后的冠状动脉血流减慢,引起一过性血栓形成,血流冲刷血栓导致末端栓塞。我们建议:如急性心肌梗死直接PCI术后可见支架远端严重心肌桥,且前降支较为粗大,并伴有慢血流时,建议置入IABP,或应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂,以预防再梗死的发生。

Acute myocardial infarction and re-infarction is associated with myocardial bridging on rare occasions. We reported 2 cases of acute myocardial infarction(AMI) induced by myocardial bridge and re-infarction after primary percutaneous coronary intervention (PCI). These 2 patients were acute anterior wall myocardial infarction primary PCI were performed during admitted, the target vessels were recanalized, but the blood flow was slow (TIMI gradeⅡ). The patients complained intense chest pain after procedures, the EKGs showed ST segment elevation, and the coronary angiography showed patent arteries without in -stent thrombosis and myocardial bridge with 85-90% systolic compression at distal of implanted stent. The potential mechanism was that the slow blood flow after re- canalization due to the compression of myocardial bridge induced transient thrombosis and distal embolization. We suggested that the intra-aorta balloon bumping (IABP) or GP Ⅱb/Ⅲa antagonist should used to prevent re-infarction when blood flow slowed after PCI associated with myocardial bridging.