急性心肌梗死伴完全性左束支传导阻滞患者急诊冠状动脉造影和心电图的相关性研究  

Correlative study of coronary angiography and electrocardiogram in patients with acute myocardial infarction and complete left bundle branch block

作　　者：肖毅[1] 董洪武[1] 谭丽玲[1] 

机构地区：[1]北京市石景山医院心内科,北京100043

出　　处：《中国循证心血管医学杂志》2017年第6期734-737,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨急性心肌梗死(AMI)伴完全性左束支传导阻滞(CLBBB)患者急诊冠状动脉造影和心电图的相关性。方法回顾性研究32例急性AMI伴CLBBB且行急诊冠状动脉造影的患者,采用Gensini及sgarbossa评分对冠状动脉狭窄程度及心电图进行评价,分析急诊冠状动脉造影和心电图的相关性。结果心功能Killip分级≥2级及冠状动脉三支病变的患者分别为25例(78.1%)及18例(56.3%)。20例新发左束支传导阻滞(LBBB)患者中有16例(80.0%)梗死相关血管(IRA)为前降支,其余4例(16.0%)IRA为右冠状动脉,12既往存在左束支传导阻滞病史的患者中,6例(50.%)IRA为前降支,其余6例(50.%)IRA为右冠状动脉。当评分≥3分时,改良sgarbossa标准诊断AMI的例数(26例,81.3%)明显高于sgarbossa标准(14例,43.8%)。冠状动脉造影提示的三支病变、双支病变、单支病变与心电图改变的sgarbossa标准和改良sgarbossa标准间不存在相关性。Gensini评分与分析心电图改变的sgarbossa标准(r=0.889,P<0.05)和改良sgarbossa标准(r=0.905,P<0.05)呈正相关关系。结论 AMI伴CLBBB患者常累及前降支,且心功能较差。改良sgarbossa标准对伴CLBBB的AMI诊断具有重要价值。Objective To investigate the correlation between emergency coronary angiographies and electrocardiogram in the patients with acute myocardial infarction （AMI） and complete left bundle branch block （CLBBB）. Methods Thirty-two patients with AMI and CLBBB received emergency coronary angiography were retrospectively and consecutively enrolled for analysis. Gensini score and sgarbossa score were calculated for each patient and used for correlation analysis. Result The number of patients with Killip class ≥2 and three-vessel coronary disease were 25 （78.1%） and 18 （56.3%）, respectively. Among patients with new onset of LBBB, 16 patients had infarction related arteries （IRAs） with anterior descending branches, 4 patients had IRA with right coronary arteries. Among patients with previous history of LBBB, 6 patients had IRAs with anterior descending branches and 6 patients had IRA with right coronary arteries. The number of patients diagnosed as AMI with modified sgarbossa standard （n=26, 81.3%） was higher than those with sgarbossa standard （n=14, 43.8%） when use the cut-off of score≥3. There was no significant correlation of sgarbossa standard or modified sgarbossa standard with the three lesions, double branch lesions and single branch lesions assessed by coronary angiography. Gensiniscore was positively correlated with sgarbossa standard （r=0.889, P〈0.05） and modified sgarbossa standard （r=0.905, P〈0.05）. Conclusion The IRAs with anterior descending branches and cardiac dysfunction were common in patients with AMI and CLBBB. Modified Sgarbossa criteria has important value in the diagnosis of the patients with AMI and CLBBB.

关 键 词：急性心肌梗死 完全性左束支传导阻滞 冠状动脉造影 心电图 

分 类 号：R541.4[医药卫生—心血管疾病]