以晕厥为首发症状的急性心肌梗塞相关血管分析

目的:探讨以晕厥为首发症状的急性心肌梗塞(AMI)与梗塞相关血管之间的关系。方法:对200例急性ST段抬高型心肌梗塞(STEMI)并进行急诊经皮冠状动脉介入治疗(PCI)患者中15例以晕厥为首发症状的梗塞相关血管进行分析。结果:以晕厥为首发症状的患者在26例梗塞相关血管为左回旋支者中有5例(占19.2%);65例梗塞相关血管为右冠状动脉者中有7例(10.8%);109例梗塞相关血管为左前降支者有3例(2.8%),梗塞相关血管为左前降支者的晕厥为首发症状的发生率显著低于梗塞相关血管为右冠状动脉,及左回旋支者(P0.05)。结论:梗塞相关血管为左回旋支或右冠状动脉的AMI患者,晕厥的发生率显著高于梗塞相关血管为左前降支的AMI患者。     

Acute myocardial infarction with simultaneous occlusions of two major coronary arteries in a young man

Simultaneous formation of the thrombi in two different coronary arteries is a very rare event. We present a 34-year-old man with acute myocardial infarction due to simultaneous occlusion of the two major coronary arteries. His only risk factor was smoking 40 cigarettes daily. Emergency arteriography revealed a total occlusion of the proximal left anterior descending artery (LAD) and the left circumflex coronary artery (LCx). We performed primary angioplasty to the LAD and instituted thrombolytic therapy to the LCx. During intra-aortic balloon pumping and medical treatment, the patient had no symptoms of angina. He underwent a second catheterization 4 weeks after primary angioplasty. After intravenous ergonovine provocation, coronary arteriography revealed diffuse vasospasm of the LAD and the LCx. These data suggest that habitual heavy smoking and coronary spasm may have been causatory factors for myocardial infarction in this case.     

Spontaneous coronary artery dissection with multiple coronary artery aneurysms in a patient with diabetic ketoacidosis

Spontaneous coronary artery dissection (SCAD) is a very rare and commonly fatal condition that typically presents with signs and symptoms of an acute myocardial infarction and cardiogenic shock. We herein present a case of a 54-year-old woman who was diagnosed with diabetic ketoacidosis (DKA) as the first manifestation of her underlying diabetes mellitus, while being hospitalized for treatment, she was found to have a non ST-elevation myocardial infarction (NSTEMI), an urgent cardiac catheterization revealed a complete dissection of the right coronary artery (RCA) with an intraluminal thrombus formation and multiple aneurismal dilatations in the left anterior descending (LAD) and left circumflex (LC) arteries. The patient underwent coronary artery bypass grafting with a favorable outcome.     

Spontaneous coronary dissection complicating unstable coronary plaque in young women with acute coronary syndrome: case reports

Spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction is a rare event. It occurs mostly in young women without traditional risk factors for coronary artery disease, particularly during the peripartum period. We describe two occurrences of SCAD in young women in whom coronary atherosclerosis was also present. In both cases, angiography showed extended coronary dissection on the left anterior descending coronary artery (LAD), starting from an atheromasic stenosis on the middle LAD segment. Coronary dissection could complicate an unstable atheromasic plaque, especially in young women presenting with acute coronary syndrome.     

PCI in a case of dual (type IV) LAD with anomalous origin of the LCx from RCA

Dual left anterior descending coronary artery (LAD) originating from the left main stem and the right coronary artery (type IV LAD) is a rare congenital anomaly. Its association with an anomalous origin of the left circumflex (LCx) from RCA is even rarer.We describe a patient presenting with acute inferior wall myocardial infarction, who was subsequently found to have this coronary anomaly. He underwent staged PCI of the dominant RCA and anomalous LCx successfully through the radial route.We conclude that anomalous coronaries can be safely and successfully treated through the radial route after careful evaluation of origin and course of the anomalous vessels. CT coronary angiography is extremely useful in delineating the vessel course and particularly their relation to great arteries.     

Nonsymptomatic myocardial bridge causing systolic total narrowing of circumflex artery

Myocardial bridge is defined as the narrowing of any coronary artery segment in systole but a normal diameter in diastole. It is most frequently seen on left anterior descending (LAD) artery. Left circumflex artery (LCx) is very rare. A 62 year-old male patient presented with severe, squeezing chest pain. The electrocardiogram showed T wave inversion in V1–V4 and ST depression in DII, DIII, aVF. Coronary angiography showed complicated lesion on after S2 branches of LAD and myocardial bridge causing 100% systolic narrowing of fourth obtus marginal branch of LCx. Bare metal stent was placed to LAD lesions with no residual occlusion. The patient was discharged with beta-blocker therapy. He had no recurrent chest pain during six months of follow-up.     

低血钾与急性心肌梗死的梗死部位冠状动脉病变及预后的关系

目的探讨低血钾与急性心肌梗死的梗死部位、冠状动脉病变及预后的关系。方法根据心肌梗死早期血钾水平把110例患者分为低血钾组、正常血钾组,对比两组的梗死部位、冠状动脉病变特征、并发症和预后情况。结果急性心肌梗死患者低血钾36例(占32.7%),其中广泛前壁心肌梗死(57.1%)与下壁(23.9%)相比更易合并低血钾(P<0.01)。低血钾组的梗死相关血管更多为前降支(55.6%)和近段病变(55.6%),与对照组差异有统计学意义(分别为P=0.01,P=0.03)。低血钾组心力衰竭、严重心律失常、梗死后心绞痛等并发症发生率显著高于正常血钾组(均为P<0.05)。结论急性心肌梗死合并低血钾的梗死相关血管多为近段病变,多为前降支,预后相对较差。     

Out-of-hospital ventricular fibrillation in patients with acute myocardial infarction: coronary angiographic determinants

OBJECTIVES: The study intended to compare the acute coronary anatomy of patients with acute myocardial infarction (AMI) complicated by out-of-hospital ventricular fibrillation (VF) versus patients with AMI without this complication. BACKGROUND: More than half of the deaths associated with AMI occur out of the hospital and within 1 h of symptom onset. The angiographic determinants of out-of-hospital VF in patients with AMI have not been investigated in detail. METHODS: Acute coronary angiographic findings of 72 consecutive patients with AMI complicated by out-of-hospital VF were compared with findings from 144 matched patients with AMI without this complication. RESULTS: Patients with an acute occlusion of the left anterior descending coronary artery (LAD) or left circumflex coronary artery (LCx) had a higher risk for out-of-hospital VF compared with patients with an acute occlusion of the right coronary artery (RCA) (odds ratio and 95% confidence interval, respectively, 4.82 [2.35 to 9.92] and 4.92 [2.34 to 10.39]). With regard to extent of coronary artery disease (CAD), the location of the culprit lesion in the coronary arteries (proximal vs. mid or distal), the flow in the infarct related artery (IRA), the presence or absence of collaterals to the IRA and chronic occlusions, there were no differences between the two groups. CONCLUSIONS: Acute myocardial infarction due to occlusion in the left coronary artery (LCA) is associated with greater risk for out-of-hospital VF compared to the RCA. The location of occlusion within LCA (LAD, LCx, proximal or distal), amount of myocardium at risk for necrosis and extent of CAD are not related to out-of-hospital VF.     

Intravascular ultrasound-guided coronary artery stenting for spontaneous coronary artery dissection in a case of acute myocardial infarction associated with vasospasm in a non-culprit coronary artery during the hospitalization

We report a case of spontaneous coronary artery dissection (SCAD) causing acute myocardial infarction, which was complicated by vasospastic angina (VA). The patient received intravenous administration of t-PA. Emergency coronary angiography demonstrated narrowing of the left anterior descending artery (LAD) due to SCAD. During hospitalization, the patient suffered chest pain, and ECG showed ST elevation in the inferior leads. Sublingual administration of nitroglycerin provided temporary remission. Coronary stent implantation was performed electively using intravascular ultrasound imaging. This is the first reported case of SCAD associated with vasospasm in a non-culprit coronary artery during the hospitalization.     

冠状动脉心肌桥及其临床意义

目的　探讨冠状动脉造影的病人中心肌桥的发生率及其临床意义。方法和结果　 2 557例行冠状动脉造影术的人群中 ,共检出心肌桥 1 7例 ,发生率为 0 665% ,均为左前降支心肌桥。收缩期狭窄程度 >50 %的有 1 4例 ,均有心绞痛症状 ,心电图提示有ST段移位、T波改变等心肌缺血表现 ;5例行心肌核素显像的病人提示有前壁心肌缺血。有 1例患者为陈旧前壁心肌梗塞 ,心肌桥于收缩期致 1 0 0 %血流阻断。 1 7例病人中有 3例左心室造影提示有室壁肥厚。结论　冠状动脉造影中的心肌桥现象并非罕见。心肌桥的存在可引起心肌缺血及相应的心电图、核素心肌显像缺血改变 ,严重的心肌桥压迫可引起心肌梗塞。     

320排动态容积CT冠状动脉成像与心肌灌注成像的相关性研究

目的探讨320排动态容积CT冠状动脉成像(computed tomography coronary angiography,CTCA)显示的冠状动脉狭窄程度与CT心肌灌注成像(CT myocardial perfusion imaging,CT-MPI)显示的心肌灌注缺损之间的相互关系。方法对60例冠状动脉疾病患者行CTCA及CT-MPI检查,将其结果进行统计学处理,并进行Spearman等级相关分析。结果 CTCA显示冠状动脉左前降支(left anterior descending,LAD)、左回旋支(left circumflex artery,LCX)、右冠状动脉(right coronary artery,RCA)180支,其中正常冠状动脉56支,狭窄冠状动脉124支。按照LAD、LCX、RCA三支冠状动脉供血范围统计,CT-MPI显示86支冠状动脉灌注正常,94支冠状动脉存在灌注缺损。结论冠状动脉狭窄程度与心肌灌注缺损存在正相关的关系。     

A breastfeeding woman with spontaneous coronary artery dissection and possible takotsubo syndrome: A case report

Rationale:The relationship between spontaneous coronary artery dissection (SCAD) and takotsubo syndrome (TTS) remains unclear. Coexistence of SCAD and TTS has been reported in the literature. However, the relationship between these two diseases has not yet been elucidated.Patient concerns:A 36-year-old breastfeeding woman was brought to our hospital 52 days after cesarean section because of discomfort in her left arm and convulsions.Diagnoses:She was diagnosed of acute myocardial infarction (AMI). The convulsions were attributed to lethal arrhythmia.Interventions:An immediate coronary angiography revealed that her left anterior descending artery (LAD) was Type 2a SCAD, but with no flow limitation. In addition, a 12-lead electrocardiogram (ECG) revealed improvement in ST-elevation. We chose the conservative treatment according to the patient''s needs.Outcomes:Conservative treatment was unsuccessful. She developed another acute myocardial infarction requiring another percutaneous coronary intervention (PCI) during hospitalization. From the course of hospitalization, we suspected the coexistence of SCAD and TTS.Lessons:When we treat patients with SCAD, we should consider the possibility of coexistence of TTS and confirm left ventricular wall motion. Patients with SCAD may require invasive treatment, hence, should be monitored for a while. An urgent strategy for managing patients with SCAD who require PCI should be established.     

心肌梗死后晚期血管开通前后血浆内源性硫化氢含量的变化及其意义（英文）

目的：探讨心肌梗死后晚期血管开通前后血浆内源性硫化氢含量的变化及其意义。方法：选择冠脉造影明确的,未经溶栓的初次心肌梗死患者60例,分为单纯前降支近段闭塞后成功开通组（20例）、单纯右冠近段完全闭塞后成功开通组（20例）和双支病变闭塞后成功开通组（20例）,用分光光度法检测各组血管开通前后内源性硫化氢含量。结果：与血管开通前内源性硫化氢水平比较,开通后前降支病变组[（24.44±3.27）μmol/L比（37.47±2.38）μmol/L]、右冠病变组[（24.48±3.60）μmol/L比（37.22±2.56）μmol/L]、双支病变组[（20.41±2.22）μmol/L比（30.34±2.37）μmol/L]内源性硫化氢水平明显升高（P均〈0.05）。结论：心肌梗死后晚期开通血管使血浆内源性硫化氢含量显著增加;对患者的预后是有益的。     

A milestone in prediction of the coronary artery dimensions from the multiple linear regression equation

Bachground /aimCoronary artery imaging is one of the most commonly used diagnostic methods. We aimed to investigate whether there is a correlation between left main coronary artery (LMCA), left anterior descending artery (LAD) and left circumflex artery (LCx) artery dimensions in normal cases and a possibility to express the coronary dimensions by multiple linear equations.Materials and methodsImages of coronary angiograms of 925 normal cases selected from 3855 cases made up the study population (515 men and 410 women; age range, 30–75 years). The mean age of the patients was 55.50 ± 6.49 years. The mean body mass index was 24.79 ± 1.45 kg/m² (range, 31.30–21.26 kg/m²). The mean dimensions of LMCA, LAD and LCx were 4.18 ± 0.65 mm, 3.22 ± 0.63 mm and 3.07 ± 0.65 mm, respectively. Correlation between LMCA, LAD and LCx diameters was investigated. Multiple linear regression analysis was used to develop a model to elucidate the relationship between LMCA, LAD and LCx diameters.ResultsThere was a strong correlation between LMCA dimensions and LAD and LCx dimensions (r = 0.526**, p < 0.001* and r = 0.469**, p < 0.001*, respectively). The positive correlation indicated that a regression analysis can be carried out by incorporating the measurements. Coronary artery dimensions were gender specific.ConclusionThe present study explored the possibility of explaining the relationship with the LMCA and its branches by multiple linear equations, which may then be used to estimate the reference diameter of a stenosed coronary artery when the other two arteries are normal.     

Percutaneous Coronary Intervention for Chronic Total Occlusion in Single Coronary Arteries

We retrospectively compared the results of percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) for chronic total occlusion (CTO) in single coronary arteries to determine whether outcomes depend on the artery involved.From January 2004 through November 2015, a total of 731 patients were treated at our center for CTO in the left anterior descending coronary artery (LAD) (234 patients, 32%), left circumflex coronary artery (LCx) (184, 25.2%), or right coronary artery (RCA) (313, 42.8%). We further classified patients by treatment (PCI or OMT) and compared the cumulative incidence of major adverse cardiac events (MACE) and the composite of total death or myocardial infarction, as well as change in left ventricular ejection fraction from baseline.The 5-year cumulative incidence of MACE was similar between the treatment groups regardless of target vessel. The 5-year cumulative incidence of the composite of total death or myocardial infarction was significantly lower after PCI than after OMT or failed PCI in the LCx (2.6% vs 11.5%; P=0.020; log-rank) and RCA (5.8% vs 17.2%; P=0.002) groups, but not in the LAD group. Cox proportional hazards regression analysis indicated that PCI independently predicted a lower incidence of the composite of total death or myocardial infarction in the LCx group (hazard ratio [HR]=0.184; 95% CI, 0.0035–0.972; P=0.046) and the RCA group (HR=0.316; 95% CI, 0.119–0.839; P=0.021).The artery involved does not appear to affect clinical outcomes of successful PCI for single-vessel CTO. Further investigation in a randomized clinical trial is warranted.     

冠状动脉搭桥围术期急性心肌梗死紧急再搭桥

目的：回顾性分析冠状动脉搭桥围术期急性心肌梗死急诊再搭桥的临床经验。方法：在510例冠状动脉搭桥患中，5例患在术后4h内因急性心肌梗死需急诊再搭桥，发生率0．98％。5例患中，男女比例为4：1，年龄56－77岁（平均63．6岁），均为冠状动脉三支血管病变（3例伴左主干病变），手术中搭桥3－5支（人均搭桥3．6支），左乳内动脉桥5根，其余为大隐静脉桥。2例在关胸后20min，3例在回重症监护病房后2－4h出现急性心肌缺血表现（明显心电图ST－T变化），伴室颤2例，5例血液动力学均不稳定，药物处理难以稳定血液动力学。全部患均立即送手术室（2例仍在手术室），急诊再次开胸。探查发现，2例患静脉桥（分别搭桥到回旋支第二钝缘支和右冠状动脉后降支）内急性血栓形成；另3例所有静脉桥良好，但左室前壁收缩运动明显减弱，结合心电图变化，诊断为左乳内动脉灌注不良。重新建立体外循环，清除桥内血栓重新搭桥2例（1例在非体外循环心脏跳动下进行）；另取一段静脉搭桥到左乳内动脉－左前降支吻合口远端的左前降支3例。结果：5例患顺利度过手术，均置入主动脉内球囊反搏，支持22－25h（平均42h）。手术后呼吸机支持4h－18d（平均7．3d）合并消化道出血4例，肾功能不全2例，肺部感染2例，切口感染1例。手术后住院时间12－35d，平均21d。全组均痊愈出院。结论：冠状动脉搭桥围术期急性心肌梗死应重在预防。如怀疑桥有问题，急诊再搭桥是良好选择，但手术后并发症发生率明显增加。     

Coronary angiography of pregnancy-associated coronary artery dissection: a high-risk procedure

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome occurring predominantly in young women without any cardiovascular risk factors, especially during the peripartum and early postpartum period. Here, we report a case of a 28-year-old pregnant woman who was found to have an isolated distal SCAD of the left anterior descending artery (LAD). Coronary angiography was complicated by extensive LAD and circumflex arteries dissection, requiring an emergency coronary artery bypass grafting associated with ventricular assist device implantation and underlying the extreme fragility of coronary arteries in pregnant women.     

Thrombolysis in myocardial infarction frame count with angiographically normal coronary arteries and its relationship to ST-segment depression

BACKGROUND: The thrombolysis in myocardial infarction frame count (TFC) has been proposed as a simple, reproducible, objective and quantitative method to assess coronary blood flow. However, the TFC in normal coronary arteries has not been investigated in detail. The aim of this study was to determine normal TFC values and investigate their correlation with ST-segment depression during exercise testing (ET). METHODS AND RESULTS: The TFC was measured in 116 cases with normal coronary arteries who underwent ET. The ST segment was evaluated on 12-lead electrocardiograms at 60 ms after the J-point. Horizontal or downsloping ST-segment depression of > or = 0.5 mm was recorded and the sum of the depressions was calculated. When ST-segment depression > or = 1 mm compared to the level of PR segment on two or more leads was detected, the test was accepted as positive. The TFC for the left anterior descending coronary artery (LAD) was significantly higher than those for the left circumflex coronary artery (LCx) and the right coronary artery (RCA). The TFC of coronary arteries was significantly higher in patients with ET positive (for LAD, 39.5 +/- 10.7 compared with 30.1 +/- 7.6 frames; for LCx, 29.2 +/- 9.3 compared with 23.6 +/- 6.5 frames; and for RCA, 30.7 +/- 11 compared with 23.7 +/- 7 frames; P < 0.001 for overall comparisons). Women had a lower TFC than men in the LAD. Moreover, it was determined that the TFC values for the LAD, LCx and RCA significantly correlated with the sum of ST-segment depression (r = 0.57, r = 0.46 and r = 0.41, respectively, P < 0.001 for overall correlations). It was also determined that the TFC was affected by the proximal diameter of the coronary arteries. CONCLUSIONS: The results of this study highlight the differences of the TFC in normal LAD, LCx and RCA. In patients with normal coronary arteries, the fact that the TFC is higher in ET-positive than in ET-negative patients may explain false positive results of ET. Sex and coronary artery diameter should be taken into consideration in evaluating the TFC.     

26例急性心肌梗死患者急诊介入治疗的疗效

目的：观察急性心肌梗死介入治疗的临床效果。方法：对12h内发病的26例急性心肌梗死患者行急诊经皮冠脉介入术(PCI)。结果：26例中梗死相关血管28支．其中前降支12支(42．86％)．回旋支6支(21．43％)．右冠状动脉6支(21．43％)．第一对角支2支(7．1％)．第二对角支!支(7．1％)。其植入支架32枚．23例成功(88．46％)。住院期间并发心源性休克5例．其中1例死亡。结论：急性心肌梗死时行急诊PCI成功率高．并发症少。     

Involvement of the coronary artery in a patient with thromboangiitis obliterans. A case report

 We report a case of coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA) and a saphenous vein graft in a 36-year-old man with Buerger's disease. He was hospitalized in the coronary intensive care unit with a diagnosis of acute myocardial infarction. His coronary angiography showed total occlusion of the proximal segment of the left anterior descending artery (LAD) and right coronary artery. Left ventricular dysfunction was detected by ventriculography. The patient had undergone bilateral sympathectomy of the lumbar branches for distal arterial occlusions due to thromboangiitis obliterans 12 years previously. Under cardiopulmonary bypass and aortic cross-clamping, we performed endarterectomy and a complex bypass procedure to LAD. Aorta-right coronary artery bypass was also applied. A histopathological study of an endarterectomy specimen showed characteristic features of thromboangiitis obliterans. The postoperative course was uneventful and the patient was discharged on the ninth postoperative day. Received: November 19, 2001 / Accepted: February 16, 2002