右冠状动脉和左回旋支闭塞导致的急性下壁心肌梗死的临床特征研究

【】 目的 研究右冠状动脉(Right Coronary Artery,RCA)以及左回旋支(Left circumflex artery,LCX)闭塞造成的急性下壁心肌梗死患者的心电图特征以及预后。 方法 临床纳入我院2012年1月~2015年1月收治的首次急性下壁心肌梗死患者70例,患者入院后均进行常规心电图以及冠状动脉造影。 其中,RCA闭塞组患者49例,LCX闭塞组患者21例。 所有患者在发病后24h内接受直接冠状动脉介入术。 术后2周,对所有患者的心肌梗死面积进行检测,同时检测左室射血分数(Left ventricular ejection fraction,LVEF)。 此外,观察两组患者住院期间心律失常、心力衰竭或心源性休克的发生率以及死亡率等。 结果 ①RCA组患者下壁并右室梗死的发生率为28.57%,明显高于LCX组的0%； 而下壁并侧壁梗死的发生率为0%,明显低于LCX组的23.81%,差异均有显著性(P＜0.05)； ②RCA组患者IIIst↑＞IIst↑、aVL st↓＞Ist↓的发生率分别为67.35%、73.47%,LCX组患者IIIst↑＞IIst↑、aVL st↓＞Ist↓的发生率分别为14.29%、14.29%,差异均有有显著性(P＜0.05)； ③RCA组肌酸激酶同工酶(CK-MB)峰值为(344.8±101.8)U/L、心肌梗死面积为(22.53±6.75)%,LCX组CK-MB峰值为(241.3±88.5)U/L、心肌梗死面积为(15.39±7.89)%,差异均有显著性(P＜0.05)； ④RCA组患者LVEF为(49.5±11.3)%,LCX组患者LVEF为(56.3±13.1)%,差异有显著性(P＜0.05)。 结论 RCA闭塞较LCX闭塞的急性下壁心肌梗死患者心肌梗死面积更大,心功能以及预后更差。     

心电图预测急性下壁心肌梗死相关冠脉的研究

目的探讨心电图对急性下壁心肌梗死相关冠脉的预测价值。方法根据冠状动脉造影证实的梗死相关冠脉结果,将153例急性下壁心肌梗死患者分为两组:右冠状动脉(RCA)闭塞组106例,回旋支(LCX)闭塞组47例。对两组患者心电图不同导联典型心肌梗死图形的发生率及ST-T改变发生率进行分析。结果RCA组STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+V2>0的发生率均明显高于LCX组(x2=14.23,29.86,p<0.01),敏感性分别为75.8%、87.2%、70.9%、84.8%,特异性分别为83.9%、85.1%、100%、100%。LCX组①②两项均不具备、STaVF+V2<0的发生率明显高于RCA组(x2=42.43,49.26,p<0.01),敏感性分别为83.7%和94.0%,特异性均为100%。结论心电图STaVL↓>STl↓①、STIII↑>STII↑②、①+②、STaVF+Ⅴ2>0与①②两项均不具备、STaVF+V2<0对判断急性下壁心肌梗死的梗死相关动脉是RCA或LCX和闭塞位置有高度特异性,有重要的预测价值。     

急性下壁心肌梗死ST段改变特征的分析

目的结合冠状动脉造影结果,分析急性下壁心肌梗死患者心电图ST段改变的特征,探讨梗死相关动脉(IRA)的判定。方法选择197例急性下壁心肌梗死,其中右冠状动脉近段闭塞69例、右冠状动脉远段闭塞80例、回旋支(LCX)闭塞48例,患者胸痛发作12h内的心电图。结果三组以及导联间比较,右冠状动脉(RCA)闭塞可出现STaVR压低(p<0.05),同时STⅢ↑>STⅡ↑(p<0.05),STaVL压低较STI明显(p<0.05),与RCA闭塞的部位无关。结合三者,其预测RCA闭塞的敏感性84%、特异性90%、阳性预测值96%、阴性预测值60%。结论急性下壁心肌梗死早期除下壁导联ST抬高外,STⅢ↑>STⅡ↑、STaVL↓>STⅠ↓、STaVR↓提示RCA阻塞,是区别RCA闭塞或LCX闭塞的关键指标,对预后和决定是否采取血管重建治疗具有重要的参考价值。     

急性下壁ST段抬高心肌梗死直接冠脉内支架置入术靶血管判定及预后评估

目的 总结急诊介入治疗（PCI）的急性下壁心肌梗死患者心电图及临床资料,分析其对急性下壁心肌梗死患者罪犯血管判定及预后评估的作用.方法 选择2007年1月到2010年7月进行急诊PCI的急性下壁心肌梗死患者280例,根据冠脉造影结果分为右冠状动脉（RCA）梗死组及左冠回旋支（LCX）梗死组;根据临床结果分为高危急性下壁心梗组（高危组）及低危组.分析各组的心电图表现、危险因素及预后.结果 RCA组与LCX组比较,STⅢ＞STⅡ、STavL或STⅠ＞1 mm下移更多见于RCA梗死.高危组年龄比低危组偏大,糖尿病患者更多,更多出现心肌梗死溶栓治疗（TIMI）分级中的0级（无灌注）及1级（渗透而无灌注）,RCA近端闭塞及双支、三支病变患者,心电图出现STV3R-5R↑、STV7-V9↑、STV4-6↓、STV1↑、STAVR↓的比例更高.结论 心电图在急性下壁心肌梗死进行急诊PCI的患者诊断及预后判断中有重要作用,对进行急诊PCI靶血管判定有一定的协助作用.冠脉造影TIMI 0、1级,RCA近端闭塞,双支、三支病变患者,年龄偏大患者和糖尿病患者整体预后均较差.     

下壁急性心肌梗死患者心电图对梗死相关动脉定位的再评价

目的探讨ST段抬高型下壁急性心肌梗死(AMI)患者心电图对梗死相关动脉(IRA)定位的价值。方法分析76例ST段抬高型急性下壁心肌梗死患者心电图改变并与冠状动脉造影结果进行回顾性对比分析。结果①梗死相关动脉多为右冠状动脉(RCA),其次为左回旋支(LCX),分别为56例(73.7%)、20例(26.3%)。②患者心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1对判断梗死相关动脉在RCA敏感性分别为87.5%、96.4%,特异性分别为85.0%、85.0%。STV3↓/STⅢ↑>1.2对判断梗死相关动脉为LCX的特异性为94.6%。③心电图STaVF↑+STV2↓>0对于判断梗死相关动脉为RCA的特异性、阳性预测值分别为90.0%、95.8%。④心电图V1～V3导联ST段压低之和与下壁导联ST段抬高之和的比值ST(V1～V3)↓/ST(inf)↑≤0.5对于判断相关动脉为RCA的敏感性、阳性预测值分别为78.6%、91.7%。⑤心电图STV3↓/STⅢ↑≤0与心电图STV1↑预测梗死动脉在RCA近端的敏感性分别为54.5%、86.4%,特异性分别为29.4%、88.2%。结论心电图STⅢ↑/STⅡ↑>1、STaVL↓/STI↓>1,STV3↓/STⅢ↑>1.2,STaVR↓≥0.05 mV预测IRA为RCA或LCX特异性较高;STV1↑预测IRA为RCA近段的敏感性、特异性较高;而STV3↓/STⅢ↑≤0预测RCA近段闭塞结果不理想。     

不同梗死相关血管的急性下壁心肌梗死的临床特征分析

目的探讨右冠状动脉(RCA)和左回旋支(LCX)闭塞导致的急性下壁心肌梗死的临床特征。方法对连续收治的108例行急诊冠状动脉介入治疗的ST段抬高型急性下壁心肌梗死患者的临床资料进行分析,根据梗死相关血管分为两组:RCA闭塞致心肌梗死组85例(RCA组),LCX闭塞致心肌梗死组23例(LCX组),比较两组临床特征。结果 RCA组血清肌酐水平、三支血管病变、心力衰竭和三度房室传导阻滞患者比例均显著高于LCX组[(93±26)μmol/L比(79±15)μmol/L,38.8%比13.0%,34.1%比13.0%,18.8%比0,均为P<0.05],RCA组合并右心室心肌梗死的患者比例也显著高于LCX组(29.4%比0,P<0.01),两组患者右冠脉优势型、住院病死率差异无统计学意义(87.1%比69.6%,1.2%比0,均为P>0.05)。结论 RCA梗死相关的急性下壁心肌梗死患者发生心力衰竭、三度房室传导阻滞的比例高于LCX梗死相关的急性下壁心肌梗死患者。     

不同罪犯血管引起的急性下壁心肌梗死临床特点

目的分析不同罪犯血管引起的急性下壁心肌梗死患者的临床特点。方法纳入发病12 h内入院的急性下壁心肌梗死患者268例,急诊行冠状动脉造影(CAG)检查,根据不同罪犯血管将患者分为2组,右冠状动脉(RCA)组:216例为闭RCA塞;左回旋支冠状动脉(LCX)组:52例为LCX闭塞。对两组临床特征和心电图进行比较分析。结果合并右室心肌梗死,心源性休克,RCA组心力衰竭显著高于LCX组(P0.05);RCA组左室射血分数(LVEF)显著低于LCX组[(51±8)%vs.(58±10)%,P0.05];但住院死亡率等两组比较差异无统计学意义(P0.05);心电图STⅢ抬高/STⅡ抬高≥1、STV4R抬高≥1 mm、高度房室传导阻滞(AVB)、室速/室颤(VT/VF)各项指标在RCA组显著高于LCX组(P0.01)。结论 RCA和LCX梗死引起的急性下壁心肌梗死临床特征和心电图表现有差异,心电图Ⅱ、Ⅲ及V4R导联ST段变化能预测急性下壁心肌梗死患者犯罪血管,对临床治疗和预后有指导作用。     

心电图对急性心肌梗死患者梗死相关血管定位价值的再探讨

目的探讨心电图对急性心肌梗死患者梗死相关血管定位价值。方法选取我院2013年6月至2014年5月收治的急性下壁心肌梗死患者65例,分为RCA组和LCX组,均行心电图检查和冠状动脉造影,以不同心电图特征指标作为对照,观察结果。结果在各个心电图特征指标中,判定IRA为RCA特异性和阳性预测值最高的是STⅢ↑/STⅡ↑1且STa VL↓/STⅠ↓1;判定IRA为LCX敏感性、阳性预测值和阴性预测值最低的是STa VR↓≥0.1mv。结论心电图对急性心肌梗死患者梗死相关血管定位有着重要价值,可以作为临床诊断的依据。     

心电图ST段改变判断急性下壁心肌梗死患者梗死相关血管的意义

目的探讨急性下壁心肌梗死时心电图ST段改变对心肌梗死梗死相关动血管(IRA)的判断价值。方法通过对84例急性下壁心肌梗死的患者的心电图Ⅰ、aVL、Ⅱ、Ⅲ、aVR、V5、V6导联ST段偏移进行分析,并与冠状动脉造影结果进行对比。结果 (1)IRA为右冠状动脉(RCA)68例,左冠状动脉回旋支(LCX)16例。(2)ST↑ⅢST↑Ⅱ提示IRA为RCA的敏感性是93%,特异性是94%,阳性预测值(PPV)是98%,阴性预测值(NPV)是79%;ST↑ⅢST↑Ⅱ提示IRA为LCX的敏感性是81%,特异性是97%,PPV是87%,NPV是96%。(3)ST↓V3/ST↑Ⅲ的值0.5提示IRA为RCA的敏感性是90%,特异性是94%,PPV是98%,NPV是68%;ST↓V3/ST↑Ⅲ的值1.2提示IRA为LCX的敏感性是81%,特异性是97%,PPV是87%,NPV是97%。(4)ST↓aVLST↓I提示IRA为RCA的敏感性是91%,特异性是81%,PPV是95%,NPV是68%。(5)aVR导联ST段压低提示IRA为RCA的敏感性是88%,特异性是87%,PPV是97%,NPV是64%;aVR导联ST段抬高提示IRA为LCX的敏感性是81%,特异性是94%,PPV是76%,NPV是95%。(6)Ⅱ、Ⅲ、aVF导联ST段抬高伴V5、V6导联ST段抬高对梗死相关血管为RCA或LCX无预测价值。结论常规12导联心电图ST段偏移对判断急性下壁心肌梗死梗死相关血管有重要的预测价值。     

急性下壁心肌梗死时心电图与冠脉造影对比分析

目的　通过 18导联心电图 (ECG)与选择性冠状动脉造影 (CAG)对比分析 ,寻找诊断右冠状动脉 (RCA )或左回旋支 (L cx)闭塞的心电图特征。方法　 36例下壁心肌梗死患者进行 18导联 ECG与 CAG结果对比。结果　 st↑ > st↑ ,RCA闭塞组为 2 1例 (80 .7% ) ;L cx闭塞组为 5例 (15 .1% ) ,有显著差异。 V7～ V9st↑ ,RCA闭塞组 2例 (2 2 .2 % ) ;L cx组 7例 (77.7% ) ,有显著差异。 V3R～ V5 Rst↑ ,RCA组为 12例 (10 0 % ) ,L cx组 0例 (0 % ) ,有显著差异。结论　这些心电图特征在下壁心肌梗死时有助于 RCA或 L cx闭塞的临床诊断。     

Coronary artery to pulmonary artery fistulas.

Twelve patients with a total of 14 coronary artery to pulmonary artery fistulas were discovered at the time of diagnostic coronary angiography. Six patients had severe coronary artery disease, five patients had normal coronary arteriography, one patient had insignificant coronary artery disease, and one patient had rheumatic heart disease. Only two patients had characteristic continuous murmurs; one patient had a normal coronary angiogram, and the second patient had severe coronary artery disease. Ten fistulas originated from the left anterior descending artery, three from the right coronary artery, and one from the left circumflex artery. The fistulas were either composed of one large (five fistulas) or one or more small channels (seven fistulas) or poorly defined plexiform channels (two fistulas). Hydrogen studies performed in two patients were negative and dye dilution curves performed in all patients were normal. In only four out of the six patients with severe coronary artery disease, the fistulas originated from a diseased vessel and in each case the origin was proximal to the narrowing. The pathogenesis and functional role of these fistulas is largely unknown.     

Interosseous artery as an access artery in case of late radial artery occlusion

We report a new technique of arterial access through the ipsilateral interosseous artery in a case of late radial artery occlusion (RAO). RAO, although not frequent, is a limiting iatrogenic complication after transradial intervention (TRI) and precludes repeat use of the same radial artery for future procedures. Our technique involves obtaining access to the ipsilateral radial artery (RA) in the distal postocclusion segment and use of collateral channel between this segment and the interosseous artery (IOA) for advancing a guidewire and sheath in the IOA lumen and in brachial artery thereafter. © 2017 Wiley Periodicals, Inc.     

Sequential radial artery grafting three-vessel coronary artery disease

Our objective was to compare the results of revascularization by sequential radial artery (RA) grafting with a left anterior descending left internal mammary artery (LIMA)-RA t-composite grafting technique. Patients were grouped as those with proximal anastomoses performed on the ascending aorta (Group A; n = 38), and those with proximal anastomoses performed on the LIMA as t-grafts (Group T; n = 13). Neither of the two groups revealed any mortality. The average number of grafts was lower in Group T (2.23 +/- 0.43 in group T and 2.85 +/- 0.69 in group A, p < 0.05). The results of the control coronary artery angiographies were superior in Group A. The patency rate of the RA grafts was 96.8% in Group A. Of the 20 distal anastomoses performed with RA grafts in 8 patients from Group T, nine (45%) were found to be patent. The patency rates of RA grafts with sequential distal anastomoses were found to be better when the proximal anastomosis was performed on the ascending aorta rather than on the LIMA. In conclusion, sequential distal anastomosis of RA grafts seem to be safe and effective when proximal anastomoses are performed on the ascending aorta.     

Carotid artery in-stent restenosis after carotid artery stenting

Carotid in-stent restenosis is a potential long-term sequela that may occur after carotid artery stenting. We report a single-center experience with this procedure and reviewed the database for individual patient characteristics and possible management options.