不同年龄急性心肌梗死患者冠状动脉病变造影分析  

Analysis of coronary arteriogram with acute myocardial infarction in different age groups

作　　者：王毅[1] 王翔[1] 张国兵[1] 周国伟[1] 张建军[1] 刘少稳[1] 

机构地区：[1]上海交通大学附属第一人民医院心内科,上海200080

出　　处：《临床心血管病杂志》2009年第10期761-764,共4页Journal of Clinical Cardiology

基　　金：上海市科委重大项目(No:05DZ19502)

摘　　要：目的:探讨不同年龄段急性心肌梗死患者冠状动脉病变特征。方法:回顾性分析597例急性心肌梗死患者急诊冠状动脉造影结果。根据年龄分为3组:①组1,年龄<60岁,114例;②组2,年龄60～75岁,279例;③组3,年龄≥75岁,204例。应用目测法和冠状动脉病变严重度积分法分析冠状动脉造影结果。结果:①3组冠状动脉前降支(LAD)、回旋支(LCX)、右冠状动脉(RCA)3支血管发生病变的概率相似(P>0.05),但≥75岁组左主干(LM)受累的概率显著高于其余2组,P<0.01;冠状动脉病变严重程度积分无差异,分别为7.58±2.71,7.66±2.98,8.72±3.30,P>0.05;而冠状动脉病变支数随年龄增加而增加,分别为1.89±0.86,2.00±0.83,2.32±0.92,且各组间差异有统计学意义(P<0.05)。②各年龄组梗死相关动脉在LM、LAD、LCX和RCA的分布差异无统计学意义(均P>0.05)。年龄<60岁组、60～74岁组和≥75岁组梗死相关动脉"罪犯"病变狭窄程度差异有统计学意义(均P<0.01):临界病变(50%～75%狭窄)在各组中分布比率分别为2.6%、9.7%和2.9%;重度狭窄(76%～95%狭窄)的比率随年龄增加而增加,分别为18.4%、36.5%和45.6%;次全闭塞和完全闭塞病变的比率随年龄增加而减少,分别为79%、53.8%、51.5%。低危"罪犯"病变比率在年龄<60岁组、60～74岁组和≥75岁组中分别为53%、40%和35%,P<0.05;中危"罪犯"病变比例各年龄组差异没有显著性(P>0.05);高危"罪犯"病变比率组2和组3差异无统计学意义(P>0.05),其余各组差异有有统计学意义(P<0.05)。各组即刻手术成功率分别为97.3%、96.8%和97.1%,差异无统计学意义(P>0.05)。结论:不同年龄急性心肌梗死患者冠状动脉病变有不同的特点。随着年龄的增长冠状动脉病变更加复杂,但并不影响罪犯冠状动脉急诊手术即刻成功率。Objective： To analyse the coronary artery angiogram with acute myocardial infarction in different age groups. Methods： 597 consecutive patients with acute myocardial infarction were divided into three groups by age as：（1）groupl age〈60 years （n=114）; （2）group2 60~74 years （n=279） ;（3）group3 age≥75 years （n=204）. The coronary artery angiography outcomes were compared among the groups. Result：（1）The coronary lesion distri- bution among the three groups was similar in the LADs, LCXs and RCAs（P〉0.05）, except for LMs, which were more frequent in gruop3 （P〈0.01）. There was no statistical difference in the coronary severity score （CSS） among all groups （P〉0. 05）. The number of stenosis vessels （stenosis≥50%） was significantly increased with adding age （P〈0.01）. （2）No difference among all groups was found in the distribution rates of the infarct-related artery （IRA） in the LADs, LCXs, RCAs and LMs. There was significantly difference in the stenosis degree of culprit lesions among gruopl, gruop2 and group3 （P〈0.01） ： the rates of borderline lesion （50 % -75 % stenosis） were 2.6%, 9.7% and 2.9% （P〈0.05）, respectively; the rates of heavy stenosis （75%-95% stenosis） were significantly higher with adding age （18.4% vs 36.5 % vs 45.6 %, P〈0.01）. The incidences of subocclusion and acute total occlusion were significantly decreased with adding age （79% vs 53.8% vs 51. 5%, P〈0.01）. The rates of low risk culprit lesions were significantly reduced with adding age among groupl, gruop2 and group3 （53% vs 40% vs 35%, P〈0.05）. There was no statistical difference in moderate risk culprit lesions （P〉0.05） and the rates of high risk culprit lesions were increased with adding age, there were statistical differences among all groups, except for group2 and gruop3. No difference was found in the success rates of PCI among all groups（P 〉0.05）. Conclusion：There are different characteristics of coronary lesion am

关 键 词：心肌梗死 年龄 冠状动脉造影 

分 类 号：R541.4[医药卫生—心血管疾病]