心肌桥对急性ST段抬高型心肌梗死影响的研究

目的探讨心肌桥对急性ST段抬高型心肌梗死(STEMI)发病及预后的可能影响。方法顺序入选2010年1月~2014年2月北京大学人民医院因STEMI急诊行冠状动脉诊疗手术患者,收集临床资料和影像学资料。(1)探讨心肌桥对心肌梗死发生的影响:选取前降支罪犯血管STEMI患者为观察组,同期无心肌梗死(MI)病史的前降支存在病变患者为对照组,分析STEMI的危险因素;(2)探讨心肌桥对STEMI预后的影响:根据前降支罪犯血管患者住院期间有无主要不良心脏事件(MACE),将患者分为MACE组和无MACE组,判断心肌桥对心肌梗死预后的影响。结果 (1)STEMI患者中,心肌桥的检出率高于同期择期冠状动脉诊疗患者(34.5%vs 11.8%,P0.05);(2)对前降支罪犯血管的STEMI发生的危险因素进行分析,发现男性(OR 1.816,95%CI 1.227-2.688,P=0.003)、LDL-C升高(OR 2.363,95%CI 1.929-2.894,P=0.000)和心肌桥(OR2.704,95%CI 1.749-4.181,P=0.000)是STEMI发生的独立危险因素;(3)对前降支罪犯血管STEMI患者分析发现,心肌桥与住院期间MACE无关(P0.05)。结论 STEMI患者心肌桥检出率较高,前降支心肌桥是STEMI发生的独立危险因素。发生STEMI患者中,血流开通后罪犯血管的心肌桥对住院期间MACE无影响。

Effect of myocardial bridges on patients with ST- elevation myocardial infarction

Objective To explore the effect of myocardial bridges（MB） on the development and prognosis of patients with STelevation myocardial infarction（STEMI）. Methods The STEMI patients undergoing intervention diagnosis and treatment were enrolled between 2010.1 - 2014.2. Angiography and clinic data were collected.（1） To explore the effect of MB on development of STEMI patients,we selected the patients with LAD（left anterior descendent） culprit vessel as observation groups,and selected the patients of non-MI history with lesions in LAD as control group over the same period. We compared the risk factors between the two groups.（2） To explore the effect of MB on prognosis of STEMI patients,the patients were divided into 2 groups based on the major adverse cardiac events（MACE） in hospital. We compared the impact of myocardial bridges on the prognosis of STEMI patients.Results（1） The detection rate of myocardial bridges in the STEMI patients were higher than control group（34.5% vs 11.8,P〈 0.05） by angiography.（2） The risk facts of STEMI with LAD culprit artery were： male（OR 1.816,95% CI 1.227-2.688,P = 0.003）,higher LDL-C（OR 2.363,95% CI 1.929-2.894,P =0.000） and MB（OR 2.704,95% CI 1.749- 4.181,P = 0.000）. Those were independent risk factors to predict the occurrence of STEMI.（3） The patients with culprit vessel in LAD were analyzed,we found that MB did not affect on MACE in STEMI patients（P〉 0.05）. Conclusion The detection rate of myocardial bridges in the STEMI patients is 34.5%. Myocardial bridge seems to be independent risk factors to predict the occurrence of myocardial infarction. After restoration of blood flow,myocardial bridges does not affect on MACE in STEMI patients with LAD culprit artery.