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1.
目的分析非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉病变特点。方法选取2008-01-01—2016-02-29南京医科大学附属无锡第二医院收治的NSTEMI患者136例及ST段抬高型心肌梗死(STEMI)患者207例。比较NSTEMI与STEMI患者冠状动脉病变特点。结果 NSTEMI患者左前降支(LAD)病变发生率低于STEMI患者,左回旋支(LCX)、左冠状动脉主干(LM)发生率及侧支循环形成者所占比例、多支病变者所占比例高于STEMI患者(P0.05)。130例NSTEMI患者中,单支病变者49例(占37.6%),双支病变者35例(占26.9%),三支病变者46例(占35.5%);完全闭塞者30例(占23.0%),90%≤狭窄率100%者93例(占71.5%),50%≤狭窄率90%者7例(占5.5%)。结论 NSTEMI患者以LCX、LM病变及多支病变为主。  相似文献   

2.
目的比较非ST段抬高型急性心肌梗死(NSTEAMI)与ST段抬高型急性心肌梗死(STEAMI)冠状动脉病变的特点。方法回顾NSTEAMI与STEAMI患者的临床及冠状动脉造影资料,分析二者的临床特点及冠状动脉病变血管的支数、狭窄程度及侧支循环情况。结果NSTEAMI组的多支病变率为76.00%、≥75%的严重狭窄率为53.00%,侧支循环率为36.00%,三者均高于STEAMI组,而完全闭塞率为10.00%,低于STEAMI组。两组间高血压、糖尿病患病率差异无统计学意义。在病变血管的构成上组间无差异。结论NSTEAMI的冠状动脉病变程度高于STEAMI,完全闭塞率低于后者,二者具有不同的冠状动脉病变特点。  相似文献   

3.
目的:比较非ST段抬高型与ST段抬高型急性心肌梗塞(AMI)病人冠状动脉血管造影结果。方法:回顾分析我院接受冠脉造影的268例AMI患者的资料,患者被分为A、B两组:A组为非ST段抬高型AMI(NSTEMI)。共148例,B组为ST段抬高型AMI(STEMI),共120例。结果:非ST段抬高型AMI组冠脉造影病变的血管数及血管狭窄程度明显高于ST段抬高型AMI组的(P〈0.01)。4年随访中NSTEMI组死亡19例(12.8%)。STEMI组死亡9例(7.5%),NSTEMI组死亡率显著高于STEMI组(P〈0.01)。结论:非ST段抬高型AMI的病情较ST段抬高型AMI更重。  相似文献   

4.
目的对比急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)与急性非ST段抬高型心肌梗死(acute non-ST-segment elevation myocardial infarction,NSTEMI)的临床特征。方法收集2012年1月至2013年12月在高淳区人民医院住院的急性心肌梗死(acute myocardial infarction,AMI)患者480例的临床资料,分为STEMI组205例,NSTEMI组275例。对比两组相关临床资料。应用多因素Logistic逐步回归分析AMI患者中发生NSTEMI的危险因素。结果与STEMI组比较,NSTEMI组女性、既往合并心纹痛、心肌梗死及经皮冠状动脉介入治疗、原发性高血压(高血压)、三支病变、侧支循环的患者比例偏高,差异有统计学意义(P0.05);空腹血糖、总胆固醇、低密度脂蛋白胆固醇、纤维蛋白原、超敏C-反应蛋白浓度偏低,差异有统计学意义(P0.05)。陈旧性心肌梗死、侧支循环、心纹痛是发生NSTEMI的独立危险因素(OR=8.049,95%CI:2.081~31.130,P=0.003;OR=3.327,95%CI:1.387~7.981,P=0.007;OR=2.435,95%CI:1.418~4.181,P=0.001)。结论陈旧性心肌梗死病史、侧支循环建立、心纹痛病史可能是AMI患者中发生NSTEMI的独立危险因素。  相似文献   

5.
急性心肌梗死根据是否伴有ST段抬高分为ST段抬高心肌梗死(STEMI)和非ST段抬高心肌梗死(NSTEMI)。NSTEMI发病的主要机制是在斑块损伤的基础上诱发急性血栓形成,如血栓为非闭塞性,或虽为闭塞性,但其远端已有侧支循环形成,多造成NSTEMI。NSTEMI与STEMI在住院病死率和远期预后方面差异无统计学意义,而后者在临床上更为常见,其危险程度和预后变异很大。本研究的目的是探讨联用波立维和低分子肝素钠治疗NSTEMI的有效性和安全性。报道如下。  相似文献   

6.
非ST段抬高心肌梗死(NSTEMI)是指具有典型的缺血性胸痛,持续超过20min,血清心肌坏死标记物浓度升高并有动态演变,但心电图不具有典型的ST段抬高,而是表现为ST段正常,压低等非特征性改变的一类急性心肌梗死。NSTEMI病理基础主要是冠脉斑块损伤的基础上诱发急性非闭塞性血栓,或虽为闭塞性血栓,但侧支循环较好,病理学形态研究证实ST段抬高心肌梗死(STEMI)冠脉内含大量纤维蛋白的红色血栓,而NSTEMI为富含血小板的白色血栓。因此在治疗上同STEMI不尽相同,下面就近年来NSTEMI药物治疗和介入治疗作一回顾,综述如下。  相似文献   

7.
目的 总结非ST段抬高急性心肌梗死(NSTEMI)的临床特点,为治疗及预后提供资料.方法 对37例NSTEMI与51例ST段抬高急性心肌梗死(STEMI)患者比较,记录NSTEMI与STEMI患者的是否有高血压,高血脂,糖尿病病史,急性心肌梗死后的并发症和死亡率.查心肌酶(CK,CK-MB)、肌钙蛋白T峰值,超声心动图测定左室射血分数(LVEF),室壁运动情况;进行冠状动脉造影,了解冠状动脉情况.结果 两组患者中高血压、高血脂症、糖尿病病史间差异无显著性意义(P>0.05);NSTEMI组CK,CK-MB,肌钙蛋白T峰值明显低于STEMI组(P<0.05),LVEF、空腹血糖高于STEMI组(P<0.05);STEMI组室壁瘤形成5例,在NSTEMI组未出现.STEMI组发生心源性休克1例,无死亡病例;NSTEMI冠状动脉2支病变明显高于STEMI组(P<0.05).结论 NSTEMI患者临床症状往往比较轻,住院并发症低,但其基础病变重,长期预后较差,有可能发生再梗,需及时进行冠脉血运重建.  相似文献   

8.
目的 探讨非ST段抬高性心肌梗死与ST段抬高性心肌梗死的临床特征.方法 回顾分析我院急性心肌梗死126例的临床资料,根据心电图有无ST段抬高分为两组,对比分析其临床特征,从而用于指导治疗.结果 非ST段抬高性心肌梗死病人既往多有糖尿病及心绞痛病史,患者冠状动脉病变较弥漫,有侧支循环建立;而ST段抬高性心肌梗死病人易合并有心律失常、心源性休克等表现,冠脉病变多为单支,两者死亡率无明显差异.结论 非ST段抬高性心肌梗死易发生于糖尿病患者,既往有反复心绞痛发作病史,冠脉病变多为多支,多有丰富侧支循环,但预后差.  相似文献   

9.
目的对比ST段抬高型心肌梗死(STEMI)与非ST段抬高型心肌梗死(NSTEMI)患者的发病特点及其预后影响因素。方法选取2013年1月—2015年7月荆州市中心医院收治的AMI患者120例,根据心电图表现分为STEMI组56例和NSTEMI组64例。回顾性分析两组患者临床资料,包括一般资料(年龄、性别、体质指数、合并症、吸烟史、Killip分级及入院时心肌梗死面积)、发病特点(首发症状、就诊时间、冠状动脉病变支数及侧支循环情况)。所有患者随访截至2016年7月,分析其预后及预后影响因素。结果两组患者性别、高血压发生率、糖尿病发生率、高脂血症发生率、吸烟史阳性率、Killip分级为Ⅲ~Ⅳ级者所占比例、入院时心肌梗死面积≥20%者所占比例比较,差异无统计学意义(P0.05);STEMI组患者年龄小于NSTEMI组,体质指数≥25 kg/m~2者所占比例低于NSTEMI组(P0.05)。STEMI组和NSTEMI组患者首发症状均以胸痛为主,分别占89.3%、71.9%;STEMI组和NSTEMI组就诊时间≤8 h者所占比例均较高,分别为96.4%、78.1%;STEMI组患者冠状动脉病变支数少于NSTEMI组、侧支循环形成率低于NSTEMI组(P0.05)。120例患者预后不良60例,其中STEMI组24例、NSTEMI组36例。多元Cox回归分析结果显示,糖尿病〔HR=1.840,95%CI(1.048,3.232)〕、Killip分级〔HR=2.259,95%CI(1.829,6.221)〕、入院时心肌梗死面积〔HR=3.374,95%CI(1.301,8.750)〕是STEMI患者预后不良的危险因素(P0.05);高龄(65岁)〔HR=2.123,95%CI(1.175,3.838)〕、Killip分级〔HR=1.822,95%CI(1.033,3.316)〕、入院时心肌梗死面积〔HR=1.850,95%CI(1.021,3.258)〕是NSTEMI患者预后不良的危险因素(P0.05)。结论 STEMI患者首发症状以胸痛为主,就诊时间较早,冠状动脉病变支数和侧支循环少;NSTEMI患者首发症状以胸痛为主,就诊时间较早,冠状动脉病变支数多,侧支循环丰富。糖尿病、Killip分级、入院时心肌梗死面积是STEMI患者预后不良的危险因素,高龄(65岁)、Killip分级、入院时心肌梗死面积是NSTEMI患者预后不良的危险因素。  相似文献   

10.
正急性心肌梗死根据心电图有无ST段抬高,分为ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)及非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)。传统理论认为,NSTEMI多见于多支冠状动脉病变,其发病的病理生理学基础是冠状动脉内不稳定的粥样硬化斑块在一系列炎症因子刺激下发生溃疡、破裂,激活局部血小板,使其发生粘附、聚  相似文献   

11.
目的探讨非ST段抬高急性心肌梗死的临床特点及住院不良事件发生率。方法回顾性分析我院急性心肌梗死患者105例,分为ST段抬高组(n=68)和非ST段抬高组(n=37),分析比较两组患者的冠状动脉造影特点及住院不良事件发生率。结果冠状动脉造影示病变血管数差异无显著性意义(P〉0.05);非ST段抬高组以老年人多见(71%),其中〉60岁的女性患者占41%,相关血管不完全闭塞比例较高、累及非主支血管较多,且梗死相关血管周围多有侧支循环形成。非ST段抬高组总住院不良事件(包括心力衰竭、再次心肌梗死、再次冠脉介入治疗和脑卒中等)的发生率明显较低,差异有显著性意义(P〈0.01),但住院病死率和消化道出血发生率差异无显著性意义(P〉0.05)。结论非ST段抬高者以老年、女性患者居多,临床表现和冠状动脉造影的结果不典型,但有较好的近期预后。  相似文献   

12.
目的探讨不同类型老年急性心肌梗死患者的临床特点及血运重建状况。方法对比分析262例ST段抬高心肌梗死(STEMI)患者(STEMI组)和189例非ST段抬高心肌梗死(NSTEMI)患者(NSTEMI组)的临床特点,冠状动脉病变及院内血运重建情况。结果与NSTEMI组比较,STENM1组患者男性比例多,平均年龄相对偏小,典型胸痛症状比例高,血肌酸激酶和肌酸激酶同工酶明显高,差异有统计学意义(P<0.05)。而NSTEMI组患者伴有高血压、血脂异常和2型糖尿病比例多,差异有统计学意义(P<0.05)。NSTEMI组多支血管病变、弥漫病变、≥90%严重狭窄的梗死相关动脉(IRA)比例、IRA闭塞的侧支循环开放率均明显高于STEMI组(P<0.05,P<0.01);而IRA完全闭塞率低于STEMI组,差异有统计学意义(P<0.01)。NSTEMI组住院期间血运重建率显著低于STEMI组,差异有统计学意义(P<0.01)。2组院内主要不良心脏事件发生率类似。结论老年NSTEMI患者临床合并症较多,冠状动脉病变较重,血运重建比例低。  相似文献   

13.
目的探讨急性冠脉综合征(ACS)患者冠状动脉粥样硬化程度和血浆氨基末端脑钠肽前体、高敏C反应蛋白水平之间的相关性。方法 ACS患者120例均行冠状动脉造影术,分为不稳定型心绞痛组(UAP组)40例,急性非ST段抬高性心肌梗死组(NSTEMI组)40例与急性ST段抬高性心肌梗死组(STEMI组)40例;同期正常体检者40名作为对照组。冠状动脉病变严重程度用病变血管支数及Gensini评分表示,于入院第2天抽血检测血浆氨基末端脑钠肽前体和高敏C反应蛋白水平,并进行比较。结果 ACS各组血浆氨基末端脑钠肽前体、高敏C反应蛋白水平和Gensini评分显著高于对照组(P<0.01),ACS各组氨基末端脑钠肽前体水平比较差异有统计学意义(P<0.05),Gensini评分各组比较差异无统计学意义;STEMI组高敏C反应蛋白水平高于NSTEMI组和UAP组(P<0.01);NSTEMI组与UAP组高敏C反应蛋白水平比较差异无统计学意义。血浆氨基末端脑钠肽前体、高敏C反应蛋白水平和Gensini评分随病变支数的增加而增加。结论联合检测氨基末端脑钠肽前体和高敏C反应蛋白水平可判断ACS的严重程度,对其诊治及指导早期行有创检查均有重要参考价值。  相似文献   

14.
Background: Acute occlusion of left circumflex (LCx) or obtuse marginal (OM) arteries can present as ST elevation myocardial infarction (STEMI) or non‐ST elevation myocardial infarction (NSTEMI). NSTEMI patients (pts) with occlusions have worse outcomes than those without occlusions, but no studies specifically examine outcomes in acute myocardial infarction (AMI) pts with LCx/OM occlusion. This study aims to define the incidence of NSTEMI in pts presenting with LCx/OM occlusion and analyzes clinical characteristics and outcomes in those presenting with NSTEMI compared to STEMI. Methods and Materials: A review of our catheterization and STEMI database was performed to identify AMI pts presenting with LCx or OM occlusion from 1/1/2007 to 7/31/2009 at the Medical College of Virginia. Patients were divided into STEMI and NSTEMI groups, and a chart review was performed. Primary end‐points were in‐hospital mortality (HM), cardiogenic shock (CS), and in‐hospital CHF. Secondary end‐points included peak CK‐MB and time to catheterization, as well as combined end‐points of 1‐month mortality, and recurrent AMI and CHF. Results: Fifty‐six pts met inclusion criteria, 54% of whom presented with NSTEMI. STEMI pts were significantly more likely to meet the primary end‐points, as well as the combined secondary end‐points. They had shorter times to catheterization but larger infarct sizes. Patients with left or mixed coronary dominance were more likely to have STEMI. Conclusions: AMI pts with LCx/OM occlusion present with NSTEMI as often as STEMI. Those with NSTEMI have better outcomes, which may be related to right coronary dominance. Summary: Patients with acute LCx or OM occlusion present with NSTEMI as often as STEMI, but those with STEMI have worse outcomes. The difference in presentation may be related to coronary dominance. (J Interven Cardiol 2011;24:27–33)  相似文献   

15.
廖勇  夏剑波  陈正凯 《心脏杂志》2013,25(4):427-429
目的:分析血清新碟呤(neopterin,Npt)对评估急性冠脉综合征(ACS)冠状动脉病变的临床价值。方法:经冠状动脉造影(CAG)确诊的126例ACS患者,依据临床类型分为:ST段抬高型心肌梗死(STEMI)组45例,非ST段抬高型心肌梗死(NSTEMI)组40例,不稳定型心绞痛(UAP)组41例。采用ELISA法测定并比较各组血清Npt、白细胞介素-8(IL-8)及超敏C反应蛋白(hs-CRP)水平,分析其与冠状动脉病变类型及斑块类型的关系。结果:血清Npt浓度在STEMI组中高于NSTEMI及UAP组(P<0.05),而IL-8及hs-CRP在3组中无显著差异。血清Npt浓度在冠脉复杂病变中显著高于冠脉简单病变与冠脉临界病变(P<0.05),而IL 8及hs CRP在3种病变中无显著差异。Ⅱ型、Ⅲ型斑块患者中血清Npt浓度高于Ⅰ型斑块患者(P<0.05),而IL-8及hs-CRP在3种斑块类型中无显著差异。结论:血清Npt与冠脉综合征患者冠脉病变程度相关,可能成为有效评估ACS患者冠脉病变程度的一个指标。  相似文献   

16.
Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P 〈0.01), while CRP levels were not significantly different between patient with STEMI and NSTEMI (3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels  相似文献   

17.
目的:分析青年(18~44岁)初发急性心肌梗死(AMI)患者心肌梗死类型及危险因素变化趋势。方法:收集2007年1月至2017年12月我院18~44岁初次诊断为AMI的住院患者。通过电子病历系统提取患者年龄、性别、出院诊断等一般临床资料,高血压病史、糖尿病病史、高胆固醇血症、肥胖、吸烟和饮酒6项心血管疾病可改变危险因素相关信息以及冠状动脉造影结果。结果:共纳入青年初发AMI患者2866例,男性2739例(95.6%),年龄(38.9±4.7)岁。心血管疾病可改变的危险因素前三位分别是吸烟[2084例(72.7%)]、高血压[1170例(40.8%)]和肥胖[1084例(37.8%)]。心肌梗死类型以ST段抬高型心肌梗死(STEMI)为主(77.3%)。非ST段抬高型心肌梗死(NSTEMI)构成比呈现上升趋势,由2007年的9.2%上升到2017年的36.9%,上升了27.7%(P趋势<0.001)。NSTEMI患者中高血压、糖尿病、高胆固醇血症和肥胖者比例显著高于STEMI患者,单支冠状动脉病变者比例低于STEMI患者(P均<0.05);随着代谢危险因素(高血压、糖尿病、高胆固醇血症和肥胖)数目增多,临床表现为NSTEMI的几率增加(OR=1.39,95%CI:1.20~1.60,P<0.001);与单支冠状动脉病变患者相比,多支冠状动脉病变患者(OR=1.27,95%CI:1.05~1.54,P<0.05)以及冠状动脉正常或无明显狭窄患者(OR=2.15,95%CI:1.59~2.90,P<0.001)临床表现为NSTEMI的几率增加。2007~2017年,多个(2个以上)代谢危险因素者比例显著上升(P趋势=0.01),单支冠状动脉病变者比例显著下降(P趋势=0.001)。结论:青年初发AMI患者以男性占绝对优势,心肌梗死类型仍以STEMI为主,但NSTEMI构成比呈上升趋势,多个代谢危险因素及冠状动脉病变特点变化与NSTEMI构成比趋势变化有关。  相似文献   

18.
OBJECTIVES: The purpose of this research was to evaluate the Thrombolysis In Myocardial Infarction risk index (TRI) to characterize the risk of death among patients with non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND: The TRI, calculated from baseline age, systolic pressure, and heart rate, was established in patients with ST-segment elevation myocardial infarction (STEMI) and is predictive of mortality. Patients presenting with NSTEMI are increasing compared to STEMI and constitute a group with varied risk. METHODS: The TRI was calculated in 337,192 patients from the National Registry of Myocardial Infarction with NSTEMI. Values and outcomes were compared with 153,486 patients with STEMI classified by reperfusion status. Comparisons of baseline characteristics and clinical outcomes stratified by TRI were made. RESULTS: There was a graded relationship between the TRI and mortality in patients with NSTEMI with a >30-fold difference in mortality rates between lowest and highest deciles (p < 0.0001). The index showed good discrimination (c = 0.73). Overall mortality in the group with NSTEMI was higher (10.9%) than patients with STEMI treated with (6.6%) but lower than for STEMI patients not receiving reperfusion therapy (18.7%). The higher risk in comparison to patients with STEMI treated with reperfusion therapy was explained largely by the higher-risk profile of the population with NSTEMI. CONCLUSIONS: There is a graded relationship between TRI and mortality in patients with NSTEMI. This simple risk index provides important information about mortality in patients across the spectrum of myocardial infarction, STEMI and NSTEMI. Early identification of NSTEMI patients who are at high risk of in-hospital mortality may provide clinicians with important information for initial triage and treatment.  相似文献   

19.
Patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are increasingly being treated with percutaneous coronary intervention (PCI) and we sought to determine risk of adverse outcomes by type of MI. Patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry from 1999 to 2004 who presented with an acute MI as an indication for PCI were studied. Baseline data and in-hospital and 1-year outcomes were compared based on ST-segment elevation (STEMI, n = 903; NSTEMI, n = 583) at presentation. Patients with STEMI were younger, had fewer co-morbidities, and had less extensive coronary artery disease than did patients with NSTEMI. Angiographic success and periprocedural complications were similar by MI type. In-hospital coronary artery bypass grafting, stroke, bleeding and recurrent MI were similar but mortality was higher in patients with STEMI (4.0% vs 1.4%, p = 0.004). Cardiogenic shock was associated with the greatest risk of in-hospital death (odds ratio 26.7, 95% confidence interval 11.4 to 62.3, p = 0.0001), but STEMI was also independently predictive of mortality. At 1 year, there was no influence of MI type on outcome. Age, cardiogenic shock, renal disease, peripheral vascular disease, and cancer were predictive of death and MI. Multivessel disease and a larger number of >50% lesions were associated with the need for repeat revascularization. In conclusion, STEMI was associated with a higher likelihood of in-hospital death than was NSTEMI, but long-term outcomes after PCI were independent of MI type. At 1 year, associated co-morbidities were strongly associated with death and MI, whereas only angiographic characteristics predicted the need for repeat revascularization.  相似文献   

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