心肌梗塞后局限性心包炎的心电图诊断

急性心肌梗塞后弥漫性心包炎的心电图诊断标准为ST段的改变和P—Q段的微小变化,而局限性心包炎尚无心电图的诊断标准。最近观察到致死性游离壁破裂前的T波的不典型演变与心包炎有关。作者研究了急性心肌梗塞患者无心脏破裂的局限性心包炎的T波不典型变化的敏感性和特异性,同时评价了快速溶栓治疗对梗塞后T波振幅演变的影响。 方法和结果 200例急性心肌梗塞患者临床过程和一系列心电图作了分析。心包炎的诊断标准为:急性心梗后第一周内发生典型的胸痛、左肩部或脚部疼痛,或心包摩擦音而无相关的CK—MB再次升高,无摩擦音而症状典型也可判定为心包炎。其中43例为梗塞后     

心包积液67例心电图观察

我院1989～1992年间经临床确诊为心包积液的67例病人,进行了心电图QRS波群电压和T波改变的观察。67例病人均经超声心动图发现心包内液性暗区1.5cm以上,或抽出心包积液者。结核性心包炎11例,有低电压5例,T波倒置2例。化脓性心包炎1例,有低电压而无T波改变,缩窄性心包炎3例,2例有低电     

经皮冠状动脉介入治疗与溶栓治疗对梗死后心绞痛的影响

目的　比较经皮冠脉状动脉介入治疗 (PCI)、溶栓治疗对梗死后心绞痛的影响。方法　对 97例首次急性心肌梗死 (AMI)患者分为PCI组、溶栓组及常规治疗组 ,观察治疗后梗死后心绞痛发生情况。结果　PCI组2 2例 ,术后有 2例发生梗死后心绞痛 ;溶栓组 32例 ,有 11例发生梗死后心绞痛 ;常规治疗组 4 3例 ,有 17例发生梗死后心绞痛 ;PCI组术后梗死后心绞痛发生率明显低于溶栓及常规治疗组 (P <0 0 5 ) ,而溶栓及常规治疗组无显著性差异 (P >0 0 5 )。结论　PCI能降低梗死后心绞痛发生率 ,改善患者预后     

溶栓后早期T波倒置对闭塞冠状动脉再通的诊断价值

目的 :探讨溶栓后早期 T波倒置对闭塞冠状动脉 (冠脉 )再通的诊断价值。方法 :对 42例AMI接受溶栓治疗的患者分为 2 4h内 T波倒置组和未倒置组 ,依据临床间接血管再通标准观察两组再通情况。结果 :1两组血管再通率分别为 90 %和 2 7% ( P <0 .0 1) ;2溶栓后早期 T波倒置预示冠脉再通的敏感性、特异性和诊断价值分别为 90 %、72 %和 81%。结论 :早期 T波倒置可作为冠脉再通的可靠指标     

急性肺栓塞的心电图变化

目的 　 探讨心电图在诊断急性肺栓塞中的作用。　方法　回顾性分析近两年收治的 13例急性肺栓塞患者入院时、溶栓后及治疗 2～ 4周后心电图的变化。　结果　 (1)入院时心电图变化 :心动过速 8例 ,右束支阻滞 3例 ,V1 导联T波、V1 ～V2 导联T波、V1 ～V3导联T波、V1 ～V4 导联T波、V1 ～V5导联T波、V1 ～V6 导联T波倒置为 10、 6、 4、 3、 2和 1例 ,SⅠ >0 1mV、TⅢ 、QⅢ 、SⅠQⅢTⅢ 分别为 7、 7、 9和 7例 ;(2 )溶栓后心电图变化 :心动过速消失 7例 ,右束支阻滞消失 1例 ,胸前导联T波倒置加深 4例 ,SⅠ 变浅 ,QⅢ 减小或消失 ,TⅢ 倒置变浅或直立 3～ 4例 :(3)治疗 2～ 4周后心电图变化 :心动过速消失 ;胸前导联T波直立数增加 ,ST段回基线 ,QⅢ 进一步减小或消失 ,TⅢ 倒置变浅或直立。　结论　急性肺栓塞心电图变化是多变的 ,需动态观察并密切结合临床加以识别。     

再灌注治疗后心肌灌注状态对心电图QT离散度的影响

目的　探讨急性心肌梗死 (AMI)再灌注治疗后心肌微循环灌注状态与心电图QT离散度 (QTd)和临床预后的关系。方法　经静脉溶栓和经皮冠状动脉腔内球囊成形术 (PTCA)再灌注治疗成功的AMI患者 30 8例 ,再灌注治疗后 1h按照 12导联心电图ST段的下移幅度分为A和B两组。A组为ST段迅速下降组 (下降≥ 5 0 % ) ,共 2 2 1例 ;B组为ST段持续抬高组 (下降 <5 0 % ) ,共 87例。分别计算两组患者入院即刻、再灌注治疗后 1h和 2 4h心电图的QTd ,并进行比较。结果　A组患者CK、CK MB峰值均明显小于B组 (P <0 0 5 ) ,分别为 (315 5± 2 0 4 6 )vs(4 2 5 3± 2 76 2 ) ;(12 9± 80 )vs(181± 94 )。A组左心室射血分数明显高于B组 (5 7%vs 4 7% ,P <0 0 5 ) ,左心功能不全、梗死后心绞痛发生率均明显低于B组 (P <0 0 5 ,7 5 %vs10 4 % ;4 6 %vs 8 3% )。A组再灌注治疗后 1h、2 4h心电图QTd均明显低于B组 (P <0 0 5 ) ,分别为 (4 0± 14 )vs(4 6± 12 ) ;(37± 13)vs(4 5± 15 )。结论　AMI再灌注治疗后 ,心肌组织水平灌注状态与临床预后及QTd有相关性 ,QTd和心电图ST段回落速度是判断心肌微循环灌注状态的简易实用指标。     

急性肺栓塞心电图动态变化观察

目的　探讨急性肺栓塞心电图特点及变化规律。方法　回顾性分析 3 5例明确诊断的急性肺栓塞患者入院时、溶栓前后及出院前的心电图 ,探讨其演变规律。结果　入院时心电图 :右束支阻滞 2例 ( 5 .7% ) ,S1 Q T 10例 ( 2 8.6% ) ,T 倒置 2 5例 ( 71.4% ) ,TV1 倒置 2 2例 ( 62 .9% )。 10例患者溶栓后心电图 :5例 S1 Q T 中 4例消失 ,TV1～ 2 倒置加深或由直立变为倒置 7例 ,R AVF增高3例。出院前心电图 :部分患者胸前导联 T波倒置变浅或变为直立。结论　急性肺栓塞心电图呈动态变化 ,动态观察对诊断和治疗有指导意义     

Q波性心肌梗死后再梗死的临床分析

急性 Q波心肌梗死 12 5例 ,4年内发生再梗死 14例 (11.2 % ) ,而 1年内发生率占 8%。再梗死发生在原梗死部位的占 78.6% ,非原部位的占 2 1.4 %。再梗死患者都有严重心功能不全或心原性休克。再梗死发生的时间越早 ,并发症越重 ,病死率越高 ,其总病死率明显高于急性 Q波心肌梗死患者 (3 5 .7%vs6.6% ,P <0 .0 1)。因此 ,应加强 Q波性心肌梗死以后的Ⅱ级预防。对再梗死患者应按急性心肌梗死的治疗原则积极处理 ,尤其要加强对泵衰竭的处理 ,及时的再溶栓和抗凝治疗可提高存活率和改善预后 ,如有条件可行PTCA或旁路手术。     

心肌梗死早期T波的改变与C反应蛋白的相关性

通过应用简便、无创的心电图 (ECG)检查 ,观察急性心肌梗死 (AMI)溶栓后早期 ( 2 4h)T波的改变与炎性反应因子C反应蛋白 (CRP)的相关性及其临床意义。1　对象与方法1 .1　对象初发ST段抬高的AMI患者 62例 ,发病 4h内来诊且符合诊断标准 ,除外明显炎症感染者。男47例 ,女 1 5例 ;年龄 39～ 76( 5 3.5± 1 9.7)岁。全部患者均用尿激酶静脉溶栓治疗。1 .2　方法按溶栓常规描记心电图共 6次 ,以后每 2h描记一次至 2 4h。据 2 4h内T波的改变将 62例患者分为 3组 :①未倒置T波 (NNT)组 ,1 3例 ;②浅倒置T波组 (SNT ,NT≤ 2mm)组 ,2 9例…     

C反应蛋白水平与急性心肌梗死溶栓患者预后的临床研究

目的　观察血清C反应蛋白 (CRP)水平变化与急性心肌梗死 (AMI)溶栓治疗后再通以及 4周内患者预后的相互关系。方法　根据溶栓后血管再通情况 ,将 43例患者分为血管再通组 (32例 )和血管未通组 (11例 ) ,将溶栓后 1周内不同时间血清CRP水平变化与梗死血管再通关系、梗死后 4周内心脏事件发生率即梗死后心绞痛、再梗死、严重心律失常的发生率以及心功能状态进行对比分析。结果　 (1)血清CRP水平升高后持续下降者显示较持续升高者梗死血管再通率所占比例明显升高 ,分别为 71.9%和 3.1%(P <0 .0 1) ;(2 )前者 4周内梗死后心脏事件发生率较后者明显减少 ,其中梗死后心绞痛发生率分别为 8.3%和 6 2 .5 %(P <0 .0 1)。结论　AMI溶栓后血清CRP水平的变化在预测溶栓后再通和患者预后中具有一定的临床价值。     

T wave changes consistent with epicardial involvement in acute myocardial infarction: Observations in patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis

Objectives. This study was designed to evaluate the presence or absence of atypical T wave evolution in patients with a postinfarclion pericardial effusion but without clinically recognized postinfarction pericarditis. A second purpose was to evaluate the frequency of atypical T wave evolution in a previous study of postinfarction pericarditis.Background. Electrocardiographic (ECG) criteria involving the evolution of the T wave after an acute myocardial infarction were recently described in patients with regional postinfarction pericarditis. Atypical T wave evolution was found to have a sensitivity of 100% and a specificity of 77% for clinically recognized regional postinfarction pericarditis with or without a pericardial effusion.Methods. The hospital records and serial ECGs of 20 patients with clinically recognized postinfarction pericarditis (Group I) were reviewed. The records and serial ECGs of 20 additional patients with a postinfarction pericardial effusion without clinically recognized postinfarction pericarditis (Group II) were also examined. The type of postinfarction T wave pattern, typical or atypical, was recorded in both groups.Results. All 20 patients in Group I had atypical T wave evolution. Among the 20 patients in Group II, every patient also had atypical T wave evolution. Fifteen percent of all 40 patients with atypical T wave evolution had a non-Q wave infarction with definite or inferred postinfarction pericarditis.Conclusions. The high sensitivity of atypical T wave evolution in diagnosing regional postinfarction pericarditis was confirmed. However, similar T wave alterations were also observed when a postinfarction pericardial effusion existed in the absence of clinically recognized pericarditis. Fifteen percent of patients with atypical T wave evolution had a non-Q wave infarction with definite or inferred pericardial involvement. Thus, the presence of atypical T wave evolution may be a more sensitive indicator of a transmural infarction than the development of a Q wave.     

Coronary angioplasty in postinfarct angina]

BACKGROUND. The recurrence of transient myocardial ischemia is a frequent event in the course of acute myocardial infarction. Postinfarction angina develops more frequently after a non-Q wave infarction, and after effective thrombolysis; when uncontrolled by standard medical treatment, it is associated with an increased incidence of unfavorable cardiac events. Therapeutic strategies involve aggressive medical therapy, frequent use of early angiography, and mechanical coronary revascularization with bypass surgery or transluminal coronary angioplasty (PTCA). PATIENTS. We retrospectively examined 68 consecutive patients treated with PTCA for postinfarction angina. Of the whole, 36 (53%) had sustained a non-Q wave infarction; 29 (43%) had been treated with thrombolysis in the acute phase. Ischemia was in the infarction zone in 94% of cases; mean EF was 61.5 +/- 12%, and in 18 cases EF was < 55%. RESULTS. In 7 cases two arteries were dilated. There were no deaths related to the procedure. The overall success rate was 91.2%. Major complications occurred in 2 cases (1 acute occlusion with reinfarction, 1 major dissection requiring emergency surgery). The results are analyzed according to the time interval between index infarction and PTCA. In 28 cases (Group A) PTCA was performed within 30 days due to medically refractory symptomatology; in 40 cases (Group B) PTCA was postponed to beyond 30 days from infarction. In Group A involvement of the left anterior descending coronary artery was more frequent (75% of cases vs 40%; p = 0.009). The success rate in Group A was slightly lower than for Group B (85.7% vs 95%); the incidence of complications was higher (7.1% vs 0%), although not statistically different. At 6 month follow-up a restenosis was found in 10 cases (16% of successful PTCAs, 21% of angiographic controls). CONCLUSIONS. We conclude that for patients with postinfarction angina, selected for a suitable coronary anatomy, PTCA is an effective therapeutic option, with a high success rate, low immediate morbidity, and good mid-term results. The risk of intraprocedural complications appears only slightly higher for patients with unstable symptoms, who undergo PTCA earlier after infarction.     

Effect of Reperfusion on P‐Wave Duration and P‐Wave Dispersion in Acute Myocardial Infarction: Primary Angioplasty versus Thrombolytic Therapy

Background: Atrial fibrillation (AF) is a common arrhythmia occurring in about 10–20% of patients with acute myocardial infarction (AMI). P‐wave dispersion (PWd) and P‐wave duration (PWD) have been used to evaluate the discontinuous propagation of sinus impulse and the prolongation of atrial conduction time, respectively. This study was conducted to compare the effects of reperfusion either by thrombolytic therapy or primary angioplasty on P‐wave duration and dispersion in patients with acute anterior wall myocardial infarction. Methods: We have evaluated 72 consecutive patients retrospectively (24 women, 48 men; aged 58 ± 12 years) experiencing acute anterior wall myocardial infarction (AMI) for the first time. Patients were grouped according to the reperfusion therapy received (primary angioplasty (PTCA) versus thrombolytic therapy). Left atrial diameter and left ventricular ejection fraction (LVEF) were determined by echocardiography in all patients. Electrocardiography was recorded from all patients on admission and every day during hospitalization. Maximum (P max) and minimum (P min) P‐wave durations and P‐wave dispersions were calculated before and after the treatment. Results: There were not any significant differences between the groups regarding age, gender, left ventricular ejection fraction, left atrial diameter and volume, cardiovascular risk factors, and duration from symptom onset to treatment. P‐wave dispersions and P‐wave durations were significantly decreased after PTCA [Mean P max was 113 ± 11 ms before and 95 ± 17 ms after the treatment (P = 0.007)]. Mean PWd was 46 ± 12 ms before and 29 ± 10 ms after the treatment (P = 0.001). Also, P max and PWd were significantly lower in PTCA group (for P max 97 ± 22 ms vs 114 ± 16 ms and for PWd 31 ± 13 ms vs 55 ± 5 ms, respectively). Conclusions: Primary angioplasty reduces the incidence of AF by decreasing P max and P‐wave dispersion.     

急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗     

The electrocardiographic diagnosis of regional pericarditis in acute inferior myocardial infarction

The diagnosis of postinfarction localized (regional) pericarditishas remained elusive. During the course of a recent study ofpatients with fatal free-wall rupture, an atypical pattern ofT-wave evolution was observed during the days preceding death.It was learned, from autopsy examination, that these electrocardiographicchanges were due to the associated localized pericarditis, ratherthan the rupture, per se. Therefore, this investigation wasundertaken to ascertain if the same atypical T-wave changesoccur in patients with postinfarction localized pericarditis,but without free-wall rupture, and to determine if the frequencyof those changes differs between those patients with inferiorand those with anterior postinfarction pericarditis. Forty-three patients with regional postinfarction pericarditiswere identified clinically. They were divided into three groups,anterior (17), inferior (17) and lateral or posterior (9) myocardialinfarction. In this report those patients with anterior regionalpostinfarction pericarditis are compared with those with inferiorpostinfarction pericarditis. It was found that an atypical T-waveevolution pattern — either persistently positive T-wavesafter 48 h or reversal of initially inverted T-waves after 48h — existed in every patient irrespective of infarct location. However, the two atypical patterns of T-wave evolution occurredwith distinctly different frequencies between the two sitesof infarction. With inferior post infarction pericarditis, gradualreversal of initially inverted T-waves occurred in 14 patients(82%) while only three (18%) had persistently positive T-waves.Conversely, among patients with anterior postinfarction pericarditis,reversal after inversion occurred in five of 17 patients (29%)while 12 of 17 patients (71%) had persistently positive deflections(P<0.01). The only other processes observed which affected the T-waveevolution in a similar manner were patients who had had cardiopulmonaryresuscitation performed and four patients with very small, initialinfarcts who had rapid reversal of initially inverted T-wavesdue to the very early administration of lytic therapy. Therefore,atypical postinfarction T-wave evolution is a very sensitive(100%) and reasonably specific (77%) sign of postinfarctionregional pericarditis.     

Thromboembolic complications of percutaneous transluminal coronary angioplasty for myocardial infarction

To determine the incidence of thromboembolic complications of percutaneous transluminal coronary angioplasty (PTCA) in the setting of recent and acute myocardial infarction, the clinical sequelae and coronary angiographic findings were examined in a series of 13 patients who underwent PTCA either as acute intervention during the infarction or as treatment for recurrent myocardial ischemia that occurred soon after the initial completed infarction. In all cases, the angiographic appearance in the infarct-related artery was that of thrombus in the setting of total or subtotal occlusion. Balloon dilatation without antecedent thrombolytic therapy, was performed in 14 arteries and was successful in establishing reperfusion with reduction of the degree of intraluminal narrowing to less than 50% in all cases. Residual thrombus at the site of inflation was noted in two cases (15%), and embolization was noted in four cases (29%), for an incidence of complication of 44%. In five of six instances in which either residual thrombus or embolization were noted, the initial infarction had occurred greater than 24 h before. In only one of seven cases in which PTCA was used as acute intervention during infarction of less than 4 h duration was the presence of residual thrombus noted after PTCA. Therefore, these findings suggest that thromboembolic complications after PTCA in the setting of recent or acute myocardial infarction are uncommon when the syndrome is less than 4 h duration; however, complications are relatively frequent when infarction has occurred greater than 24 h before. PTCA as a primary intervention in this latter setting should be approached cautiously.     

Pericardial involvement in acute myocardial infarction

The incidence of both early postinfarction pericarditis and post-myocardial infarction (Dressler's syndrome) appears to be declining. Pericardial pain and pericardial friction rub define early postinfarction pericarditis and usually develop on day 2 or 3 after a transmural myocardial infarction. The clinical course is benign, and the prognosis of the patient is not altered by development of this complication. Pericardial effusions have been found in as many as 28% of patients after acute MI. Asymptomatic pericardial effusions do not require specific therapy nor do they absolutely contraindicate the use of anticoagulation as was previously thought. The preferred form of therapy for early postinfarction pericarditis is aspirin. Avoidance of corticosteroids and NSAIDs must be considered carefully because of the reported complications of these agents. The post-myocardial infarction syndrome develops usually during the second or third week after acute MI but may be seen as early as 24 hours and as late as several months after the MI. Whether this syndrome is the result of autosensitization to myocardial antigens released into the circulation during infarction remains uncertain. Alternative hypotheses for the causation of the syndrome include the release of blood in the pericardial space and simply that the syndrome represents a prolonged and exaggerated form of early postinfarction pericarditis. Clinically, post-myocardial infarction syndrome is manifested by fever, malaise, chest pain, and the presence of a pericardial and possibly pleuropericardial friction rub. Pericardial effusion is frequently large, and, rarely, cardiac tamponade may develop and require pericardiocentesis. Treatment consists of aspirin, NSAIDs, or corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pericarditis complicating acute myocardial infarction: incidence of complications and significance of electrocardiogram on admission

The records of 31 patients with pericarditis complicating acute myocardial infarction were reviewed and compared to a control group of 274 patients with infarction but without pericarditis. The cases of pericarditis all occurred within one week of myocardial infarction and were included only if a typical pericardial friction rub was heard by more than one observer.Sex distribution and age were similar in both groups. There was a higher incidence of anterior wall infarction in the group with pericarditis. The incidence of atrial arrhythmias was less than in controls, while the incidence of ventricular arrhythmias, significant congestive heart failure, and death was slightly greater in those with pericarditis.Maximum ST segment elevation on the day of admission in the group with pericarditis was compared with a control group. In those with anterior wall infarction and pericarditis, the average ST segment elevation in the anterior precordium was 5.6 mm. compared to 2.6 mm. in the controls. In those with inferior wall infarction and pericarditis, the average ST segment elevation was 3.6 mm. in Lead III compared to 1.7 mm. in a control group.It is concluded that patients who develop pericarditis within one week of acute myocardial infarction do not have an increased incidence of atrial arrhythmias. The incidence of ventricular arrhythmias, significant congestive heart failure, and death are slightly greater and may be due to more extensive myocardial infarction. The higher initial ST segment elevation in patients with pericarditis may indicate a greater amount of injury or may be a sign of pericardial involvement that is seen before clinical pericarditis is present.     

Primary percutaneous coronary angioplasty: a protagonist's view

The wide variety of reperfusion strategies now available has led to confusion regarding the optimal therapy of patients with acute myocardial infarction. In assessing the comparative efficacy of reperfusion strategies, safety factors, recanalization rates, reocclusion rates, myocardial salvage and improvement in survival must be compared. In this analysis, primary percutaneous transluminal coronary angioplasty (PTCA) compares favorably to intravenous thrombolytic therapy or combination PTCA and thrombolytic therapy as a reperfusion strategy. Primary PTCA has not been reported to cause intracerebral hemorrhage, whereas thrombolytic strategies are associated with an incidence of a 0.2 to 1.4% rate of intracerebral bleeding. Strategies using PTCA have recanalization rates of only 33 to 75%. Disappointingly, a major failure of all reperfusion strategies (including primary PTCA) is a high rate of reocclusion and reinfarction. Primary PTCA is associated with a 7 to 16% increase in global ejection fraction. Similar improvement in ejection fraction has not been demonstrated in patients treated with thrombolytic therapy alone. Although in-hospital mortality is improved, a substantial 1-year mortality persists for intravenous thrombolytic therapy. Long-term survival is greater when PTCA therapy is used. In addition, PTCA does favorably improve survival in high-risk patients with cardiogenic shock. Although it is unlikely that most patients with acute myocardial infarction will have primary PTCA as a treatment option, this therapy remains extremely attractive for centers where primary PTCA is readily available.     

急性心肌梗死溶栓治疗中ST段再抬高的意义

目的 探讨急性心肌梗死静脉溶栓治疗中ST段再抬高产生的原因和意义。方法 通过回顾性分析31例首发急性心肌梗死病人，按静脉溶栓治疗中有无ST段再抬高分为A、B两组，比较两组间伴发疾病、再通率、并发症发生情况、CK峰值水平、梗死后心绞痛，结合冠脉造影结果进行分析。结论 静脉溶栓治疗时ST段再抬高与病人合并糖尿病、高血压病、高脂血症及再灌注损伤有关；根本原因是冠状动脉存在多支病变及梗死血管狭窄程度重所致。这类病人心肌受损较重，血管再通率低，常发生梗死后心绞痛。单纯溶栓治疗难以获得满意的效果，应重视再灌注损伤的处理，并可作为补救性PTCA的手术指征。