冠状动脉造影检查正常的急性ST段抬高型心肌梗死患者临床特征及预后分析  

Clinical Characteristics and Prognosis of Patients with Acute ST-Elevation Myocardial Infarction Having Normal Coronary Arteriongraphy

作　　者：苏岩岩 高亚松 丁超[2] 

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]解放军白求恩国际和平医院心血管内科,石家庄050082

出　　处：《临床误诊误治》2018年第2期80-83,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2014年医学科学研究课题(ZL20140138)

摘　　要：目的探讨冠状动脉造影(coronary arteriongraphy,CAG)检查正常的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者临床特征及预后情况。方法选择行CAG检查的初发STEMI 518例,根据CAG检查结果分为CAG正常组(28例)和CAG异常组(490例)两组,分析比较两组基线资料、发病特点、冠心病危险因素、入院后并发症和心功能情况以及预后情况。结果与CAG异常组比较,CAG正常组男性发病率较高,发病年龄较轻,发病前多有劳累及情绪激动等发病诱因,前壁梗死发病率低,下壁梗死发病率高,有心绞痛病史比例较低,术前心电图回降>50%及术前胸痛缓解>5分比例较高;有糖尿病、高血压病、高脂血症史比例较低,有吸烟史比例较高;节段性室壁运动异常发生率、梗死后心绞痛发生率、心功能Killi P>2级发生率及因缺血事件再次住院发生率较低,左心室射血分数较高,差异均具有统计学意义(P<0.05)。结论 CAG检查正常的STEMT患者多为年轻男性,冠心病危险因素较少,吸烟及应激性反应是其主要危险因素,临床预后较好。Objective To investigate clinical characteristics and prognosis of patients with acute ST-elevation myocardial infarction( STEMI) having normal coronary arteriongraphy( CAG). Methods A total of 518 patients with primary STEMI undergoing CAG examinations were divided into normal CAG group( n = 28) and abnormal CAG group( n = 490),and then general data,pathogenesy characteristics,risk factors of coronary heart disease,complications and heart function conditions after admission and prognosis were analyzed between the two groups. Results Compared with those in abnormal CAG group,in normal CAG group,CAG were mostly found in male,and the age of onset was younger; most patients had strenuous activity or emotional agitation before onset,incidence rate of anterior wall infarction was lower,while incidence rate of inferior wall infarction was higher,and the rate of patients having angina pectoris history was lower; rates of electrocardiogram fallout larger than 50% and chest pain remission larger than 5 scores before operation were higher; rate of patients having diabetes,hypertension and hyperlipidemia histories were lower,while rate of patients having smoking history was higher; after infarction,incidence rates of angina pectoris,cardiac function Killip larger than grade 2,segmental ventricular wall abnormal motion and rehospitalization for ischemia were significantly lower,while left ventricular ejection fraction( LVEF) score was significantly higher( P < 0. 05). Conclusion Patients with acute STEMT having normal coronary arteriongraphy are mostly young men having fewer risk factors of coronary artery disease,and smoking and stress reaction are the main risk factors,and prognoses of the patients are good.

关 键 词：心肌梗死 血管造影术 冠状动脉 危险因素 预后 

分 类 号：R542.22[医药卫生—心血管疾病]