合并急性左心衰的非ST段抬高急性心肌梗死临床及冠状动脉病变特征  

The clinical and coronary artery feature of patients diagnosised as non-ST-elevation myocardial infarction accompanied with acute left heart

作　　者：李勇[1] 邹剑杰[2] 张韬[1] 邵波[1] 

机构地区：[1]上海交通大学医学院苏州九龙医院心内科,江苏苏州215000 [2]攀枝花学院附属医院心内科,四川攀枝花617000

出　　处：《临床和实验医学杂志》2008年第12期13-14,17,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨合并急性左心衰的非ST段抬高急性心肌梗死患者的临床及冠脉病变特征,为制定干预策略及判断预后提供依据。方法回顾性分析合并急性左心衰的急性心肌梗死(AMI)患者94例的临床资料及冠脉造影结果,根据心电图有或无ST段抬高分为两组,非ST段抬高急性心肌梗死(NSTEAMI)组,ST段抬高急性心肌梗死(STEAMI)组,比较两组临床特征和冠脉病变特征。结果NSTEAMI组发病年龄大,既往心肌梗死病史、2年以上心绞痛病史、入院时无心绞痛症状、合并高血压、糖尿病、高脂血症病史者多;血中肌钙蛋白T(cTnT)、肌酸激酶、肌酸激酶同工酶的水平低;左室舒张末期内径(LVEDd)和收缩末期内径(LVESd)增大、左室射血分数(LVEF)和左室短轴缩短率(LVFS)降低明显;冠状动脉三支病变、累及左主干病变、钙化病变、侧支循环形成、弥漫性长病变、慢性闭塞病变的发生率高;STEAMI组血栓形成及急性完全闭塞病变、罪犯血管中左前降支(LAD)发生率高;性别、吸烟史、偏心性病变,分叉病变发生率,两组间差异无显著性。结论合并急性左心衰的NSTEAMI临床合并症多,入院时常无心绞痛症状,心功能较差,冠状动脉血管病变严重且复杂,但急性闭塞病变的发生率低,多为慢性进展的结果,提示预后不良,早期积极血运重建可能改善预后。Objective To investigate the clinical and coronary artery feature of the patients who were diagnosised as non - ST - elevation myo- cardial infarction accompanied with acute left heart failure. Methods Retrospective analyse the clinical data and coronary artery opacification results of 94 patients who were diagnosised as acute myocardial infarction accompanied with acute left heart failure. The patients were divided into two groups according to whether ST - elevation or not in the electrocardiogram , the non - ST - elevation myocardial infarction （ NSTEMI ） groups and the ST- elevation myocardial infarction （STEMI）groups , than contrast the clinical feature and coronary artery pathological changes between the two groups. Results Contrast to the STEMI group, the patients in NSTEMI group were elder , and most of them had myocardial infarction history , angina more than 2 years , without angina on admission , accompanied with hypertension diabetes mellitus and hyperlipoidemia, the level of troponin T, reatinkinase, creatinkinase isoenzyme in blood were lower , the internal diameters of left ventricle end - diastole and end - systolic were larger , and left ventricle ejection were depressed observely. The incidence of three vessel disease,left main artery disease, calcification disease , branch cycle formed, diffuse disease , chronic obliterated disease were higher. The incidence of acute obliteration, embolism and left anterior descending as evil vascular were higher in the STEMI group. Sexy , smoking, eccentricity disease and incidence of bifurcate disease were without predominance distinction. Conclusion There were more complications in the patients diagnosised as non - ST - elevation myocardial infarction with acute left heart failure. Most of the patients in the NSTEMI group without angina , and the heart function of them were severe , coronary artery disease were more severe and multiple, but the incidence of acute obliteration were lower, most of coronary artery disease of NSTEMI group were progressive

关 键 词：非ST段抬高急性心肌梗死 急性左心衰 冠状动脉 特征 

分 类 号：R542.22[医药卫生—心血管疾病] R541.4[医药卫生—内科学]