早期心肌再梗死和梗死延展的临床分析

急性心肌梗死(AMI)后,梗死部位心肌产生不可逆改变,一般都在24h以内逐步坏死,以后梗死范围相对稳定。在AMI 24h以后至28d以内,发生新的心肌坏死称为早期心肌再梗死(MRI)。为又一次冠脉事件。把原梗死部位发生新的心肌坏死,称为心肌梗死     

32例早期心肌再梗死或梗死延展的临床分析

目的　分析早期心肌再梗死或梗死延展发生的高危因素及其对临床预后的影响。方法　分析 3 2例早期心肌再梗死或梗死延展患者 (观察组 )的诱发因素 ,对比该组患者与 5 5例急性心肌梗死 ( AMI) (对照组 )患者在冠心病危险因素、溶栓治疗及预后等方面的差异。结果　精神因素、便秘是其发生的主要诱因。梗死后心绞痛和糖尿病及 AMI后并发心力衰竭、心律失常、心源性休克的患者发生早期心肌再梗死或梗死延展的例数明显多于对照组。观察组出现并发症及住院死亡率明显高于对照组。结论　早期心肌再梗死或梗死延展的发生 ,与 AMI后心输出量减少、冠状动脉低灌注、高凝状态、冠状动脉多支病变及侧枝循环未能及时建立有关 ,并影响其临床预后。     

血清肌红蛋白在急性心肌梗塞溶栓再通及梗塞延展中的意义

<正> 临床研究表明急性心肌梗塞(AMI)后梗死心肌内的肌红蛋白(Mb)释放入血明显早于CK及CPK-Mb,因而认为Mb是AMI早期诊断敏感的生化指标.近年来国外学者研究表明Mb也是快速诊断梗塞冠脉再通最可靠的生化指标之一,但国内尚无有关报道,本文测定了我院AMI住院患者应用尿激酶     

早期心肌再梗塞和梗塞延展的临床分析

分析急性心肌梗塞１１０６例，住院中发生梗塞延展和早期再梗塞分别有６７例（６．１％）和１１例（１．０％）。梗塞延展和再梗塞发生在初始梗塞后平均１０±７天。梗塞后早期有心绞痛患者中，梗塞延展和再梗塞的发生，非常显著地多于无心绞痛患者（１３．２％与３．７％，Ｐ＜０．００１）。梗塞延展和再梗塞患者与无梗塞延展和无再梗塞患者比较，Ｋｉｌｌｉｐ高级别者多，更多地死于心源性休克。早期再梗塞和梗塞延展患者的住院病死率明显地高于无梗塞延展和无再梗塞患者（１１．５％和５．０％，Ｐ＜０．０５）。结果提示，梗塞后早发性心绞痛患者是早期再梗塞和梗塞延展的高危者，对早期再梗塞和梗塞延展患者应持续或延长监护及充分有效的药物治疗或（和）行介入性治疗或外科搭桥术。     

早期心肌再梗塞和梗塞延展的临床分析

早期心肌再梗塞和梗塞延展的临床分析徐义枢，陆宗良，寇文，ｅｔａｌ．中华心血管病杂志，１９９４，２２（６）：４０９分析急性心肌梗塞１１０６例，住院中发生梗塞延展和早期再梗塞分别有６７例（６．１）和１１例（１．０％）。梗塞延展和再梗塞发生在初始梗塞后１０...     

老年早期心肌再梗死和梗死延展的临床分析

老年人早期心肌再梗死(EMRI)和心肌梗死延展(MIEXT)是AMI的一种特殊重要的类型。EMRI和MIEXT可使病情恶化，预后差，病死率高，应引起临床医师足够重视。本研究回顾性分析了15例老年AMI病例，探讨老年人EMRI和MIEXT的发生因素、临床特点及防治措施。     

76例心肌再梗塞尸检分析

本文将128例心肌梗塞尸检结合临床作了对比分析,其中心肌再梗塞组76例(59.4%),其他52例作为对照组。心肌再梗塞病理形态的相对特点是冠状动脉各大主支粥样硬化(AS)均较对照组重,冠脉血栓形成也较对照组多。心肌再梗塞后的并发症除心脏破裂外,均较对照组检出率为高。     

再梗塞的预测和预防

急性心肌梗塞是冠心病的重症之一,其再梗塞的发生对生命威胁较大,因此再梗塞的预测和预防具有一定的临床意义。本文旨在通过对再梗塞预测的探讨,进一步预防再梗塞的发生。     

梗塞图形的室性早搏在急性心肌梗塞早期处理中的价值

1991年4月～1992年5月所收治的93例急性心肌梗塞中有6例出现具有梗塞图形的室性早搏。该种早搏发生的时间早,在出现典型急性心肌梗塞心电改变之前发生;消失快,在呈现典型急性心肌梗塞心电图图形之后消失;其所在的导联与梗塞部位密切相关。它对急性心肌梗塞的早期诊断和治疗有一定的临床价值。     

急性心肌梗塞后非梗塞心肌异常及可能机制

急性心肌梗塞后非梗塞心肌存在病理生理，生化，电生理及起微结构等多方面的异常改变，与该区域心肌缺血，缺氧，脂质过氧化增强，离子失平衡及对儿茶酚胺敏感性增高有关，纠正了既往长期以来认为非梗塞心肌“正常”的传统观念。认为加强这方面的防治研究对改善急性心肌梗塞患者的预后具有重要的临床意义     

"Pseudo reinfarction": a consequence of electrocardiogram lead transposition following myocardial infarction

Unexpected or bizarre new electrocardiographic changes should alert the physician to the possibility of lead transposition and, if in doubt, the electrocardiogram should be repeated. The classic form of limb lead transposition leading to the appearance of dextrocardia is well recognized. We report a patient with myocardial infarction where lead transposition led to a diagnosis of reinfarction and to the inappropriate use of thrombolytic therapy.     

以QRS记分法比较心肌梗死延展和再梗死的面积及心衰、心脏性休克的发生率

目的　探讨急性心肌梗死 (AMI)后 ,近期 (4周一半年内 )再次心肌梗死 (再梗死 RI)和梗死延展 (IE)发生后二者梗死面积及心衰、心脏性休克发生率的差异。方法　对 2 32例 AMI患者采用 Wagner心电图记分法 ,选取 AMI充分发展期及 RI和 IE后的稳定期 ,进行 QRS记分。结果　 IE和 RI发生后 QRS记分值较两种病变发生前明显增加 ,P均 <0 .0 1。 RI患者 QRS记分值多于 IE患者 ,P<0 .0 5。RI患者心衰及心脏性休克的发生率明显高于 IE患者 ,P均 <0 .0 2 5。 IE和 RI后出现心衰患者发病前后 QRS记分值比较有明显差异 ,P均 <0 .0 1。无心衰患者发病前后 QRS记分值无差异 ,P均 >0 .0 5。以 QRS记分增加值 1.5分为界 ,与 IE和 RI发生前比较 QRS记分增加值超过 1.5分者心衰及心脏性休克的发生率明显多于未超过 1.5分者。结论　 RI患者的梗死面积大于 IE患者。发生 IE和 RI后梗死面积增加越多即 QRS记分增加值越大 ,心功能越差 ,心源性休克及心衰发生率越高 ,QRS记分增加值超过 1.5分者预后不佳。     

Life event stress and myocardial reinfarction: a prospective study

Earlier studies of life event stress in coronary heart disease(CHD) have been flawed by cross-sectional design and inadequatemethods for assessing life-event stress. This 3-year prospectivestudy of acute myocardial infarct (AMI) patients reveals significantindependent associations between acute and chronic stressorsat first admission, and risk of recurrent AMI and death, occurringin the 3 years of follow-up. Relative risks of reinfarction(or death from reinfarction) in the entire sample, for acuteevents and chronic difficulties were, 2·5 and 2·3respectively and were statistically significant; When subjectsadmitted with first AMI were considered alone, relative riskswere 3·1 and 4·1 respectively. The clinical significanceof these findings is discussed.     

Effect of spontaneous reperfusion on myocardial infarct size

The effect of perfusion of the infarct artery on myocardial infarct size was studied in 39 patients who had not received interventive therapy. At predischarge coronary angiography, 19 patients had subtotal and 20 total occlusion of the infarct artery. The early ST-segment elevation recorded on a 12-lead electrocardiogram was used as an index of the amount of initially jeopardized myocardium. Infarct size was estimated by peak serum creatine kinase and, at discharge, by a QRS score, sigma Q and sigma R on a 12-lead electrocardiogram, and by radionuclide global and infarct segment left ventricular ejection fraction. Despite a similar degree of initial ischemia (sigma ST), infarct size was smaller in the 11 patients with anterior infarction and subtotal occlusion than in the 9 patients with anterior infarction and total occlusion when measured by peak serum creatine kinase (2114 +/- 1192 U/l vs. 3653 +/- 1059 U/l, p less than 0.02), QRS score (5.0 +/- 2.7 vs. 9.6 +/- 3.5, p less than 0.01), sigma Q (3.25 +/- 2.74 mV vs. 5.92 +/- 3.56 mV, p less than 0.10), sigma R (4.36 +/- 1.25 mV vs. 2.16 +/- 0.91 mV, p less than 0.001), global left ventricular ejection fraction (45.0 +/- 12.2% vs. 33.4 +/- 6.7%, p less than 0.05), and infarct segment ejection fraction (40.4 +/- 8.2% vs. 30.3 +/- 5.4%, p less than 0.05). In the inferior infarct patients, both the degree of initial ischemia and final infarct size were similar in the 8 patients with subtotal and in the 11 patients with total occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

老年急性心肌梗死后心肌纤维化的研究

目的　探讨老年急性心肌梗死 (AMI)患者组织纤维化血清学指标的变化及其反映心梗早期心室重构和心肌纤维化的临床意义。方法　以放免法测定老年 AMI再通组 31例 ,未通组 1 6例及正常对照组 2 7例血清中层粘连蛋白 (L N)、 型前胶原 (PC )和透明质酸 (HA)的含量 ;并将左室舒张末期内径 (LVDd)和射血分数 (EF)与上述各参数作相关分析。结果　老年 AMI患者未通组血清 L N、PC 、HA含量较其他两组水平增高显著 ,并与 LVDd呈正相关 ;但其他两组的参数间及其与 EF的关系无统计学意义。结论　血清 LN、PC 、HA均可作为老年 AMI患者心肌组织纤维化的血清学指标 ,在临床上为判断 AMI后早期心室重构和心肌纤维化提供了间接依据。     

Relationship between electrocardiographically estimated infarct size and clinical findings in anterior myocardial infarction

In 292 patients with anterior myocardial infarction (MI) and no previous MI the electrocardiographically estimated infarct size was correlated with clinical findings during hospitalization and 3-month follow-up. Patients with ECG-defined transmural MI had a higher incidence of different types of complications, such as congestive heart failure (CHF), hypotension, pericarditis, and a longer duration of hospitalization than patients with nontransmural MI. In a subgroup including 182 patients of the total series, a precordial map containing 24 electrodes was used. The sum of R waves (ΣR), the sum of Q waves (ΣQ), the number of Q waves, and ΣR-ΣQ were calculated 4 days after arrival in hospital to estimate the size of infarction. There was generally a correlation between these ECG variables and different clinical findings, such as incidence of CHF, hypotension, pericarditis, and the duration of hospitalization. It is concluded that the ECG determined infarct size in anterior MI in a majority of patients correlates with the incidence of different types of complications in acute myocardial infarction. In the individual patient, however, the risk of developing complications cannot be predicted by ECG changes.     

The 60 Minutes Myocardial Infarction Project. Characteristics on admission and clinical outcome in patients with reinfarction compared to patients with a first infarction

Purpose The purpose of the study was to evaluate parameters that characterizepatients with myocardial reinfarction as compared to patientswith a first infarction in clinical practice, and possibly todetermine their clinical outcome. Methods The 60 Minutes Myocardial Infarction Project is a German multicentreprospective observational study in which 136 hospitals are participating.Fourteen thousand, nine hundred and eighty consecutive patientswith acute Q wave myocardial infarction were included from July1992 to September 1994. Results Out of these 14980 patients, there were 2854 (19%) with reinfarctionand 12126 (81%) with a first infarction. Patients with a reinfarctionarrived at the hospital 24min earlier than patients with a firstinfarction (pre-hospital delay 156 vs 180min;P<0·001);the door-to-needle time with reinfarction was longer (38 vs30min;P<0·001); however, patients with reinfarctionwere older (69 vs 66 years;P<0·001), had a lower rateof a diagnostic first ECG (54 vs 71%;P<0·001) andreceived thrombolytic therapy less frequently than patientswith a first infarction (46 vs 52%;P<0·001). A lownumber of patients received primary PTCA (n=205) since onlya few hospitals offered a primary PTCA service at the time thestudy was performed. In patients with reinfarction, there weremore reasons as to why thrombolytic therapy was not given (24vs 21%;P<0·001). Left bundle branch block occurredmore frequently in patients with reinfarction (15 vs 8%;P<0·001).The intra-hospital course in patients with reinfarction wasassociated with an increase of complications and intra-hospitaldeath (23 vs 15%;P<0·001). Conclusions Although reinfarction patients arrived earlier at hospital thanpatients with a first infarction, the former received thrombolytictherapy less frequently than the latter. Patients with reinfarctionwere older, more frequently had a non-diagnostic ECG on admissionand had a higher rate of contraindications against thrombolytictherapy.     

Relationship between electrocardiographically estimated infarct size and clinical findings in inferior myocardial infarction

In 270 patients with acute inferior wall myocardial infarction (MI) and no previous MI, Q- and R-wave changes in leads II, III, and aVF in a 12-lead standard ECG were related to the clinical course during hospitalization and 3-month follow-up. Patients with ECG-defined transmural MI showed a higher incidence of tachycardia, high degree of AV block, congestive heart failure (CHF), and pericarditis than patients with nontransmural MI. In a subgroup including 226 patients, the series was divided into quartiles according to the sum of Q- and R-wave changes in leads II, III, and aVF 4 days after arrival in hospital. A weak correlation between ECG-determined infarct size and the incidence of complications such as congestive heart failure (CHF), need for furosemide, and pericarditis, as well as the duration of hospitalization was observed. It is concluded that ECG-determined infarct size from leads II, III, and aVF in inferior MI is associated with the clinical course, although it cannot predict the outcome in the individual patient.     

Morbidity during five years after myocardial infarction and its relation to infarct size

In 809 patients with a recent myocardial infarction, morbidity during 5-year follow-up was assessed. The overall 5-year mortality rate was 33% (39% in patients with larger infarcts and 26% in patients with smaller infarcts) as judged from maximum serum enzyme activity (p less than .001). In terms of morbidity, no significant association with estimated infarct size was observed. Patients with smaller infarcts tended to have a higher reinfarction rate and were rehospitalized more often, whereas a similar proportion of patients with large and small infarcts developed stroke. Among survivors, chest pain tended to be more common in patients having smaller infarcts, whereas symptoms of dyspnea and claudicatio intermittens were similar in both groups, as were smoking habits, work capability, and varying forms of medication. We thus conclude that during a 5-year follow-up after acute myocardial infarction, mortality, but not morbidity, was related to the original infarct size.