急性心肌梗死患者梗死相关动脉与急诊介入术后再灌注性心律失常的相关性研究

目的探讨急性心肌梗死(AMI)患者梗死相关动脉与急诊经皮冠状动脉介入治疗(PCI后再灌注性心律失常(RA)的相关性。方法收集2013年1月至2016年6月于张家口市第一医院心内科确诊为AMI并行急诊PCI的179例住院患者,并依据梗死相关动脉分布分为三组:左前降支(LAD)组,左回旋支(LCX)组,右冠状动脉(RCA)组,并对以上行急诊PCI患者术后出现RA的资料进行分析。结果179例患者中有85例出现RA,非RA组患者术前的年龄、性别(男)、血糖、吸烟、饮酒、糖尿病史、高血压病史、空腹血糖、肌酐、总胆固醇及血钾水平均与RA组有显著性差异(P0.05);RA组梗死相关动脉分布为LAD 42例,LCX 12例,RCA 31例。LAD组快速型心律失常发生率高于RCA组(P0.05);RCA组缓慢型心律失常发生率高于LAD组(P0.05);梗死相关动脉开通时间6 h发生心律失常56例(64.37%),6 h发生RA 24例(26.09%);RA主要发生于AMI后梗死相关动脉较早开通者。结论 AMI急诊PCI后RA发生率高,心律失常的类型与梗死相关动脉有相关性,其发生率与再灌注时间有关。     

心电图在诊断急性心肌梗死相关动脉中的价值

目的分析急性心肌梗死患者不同梗死部位心电图表现及梗死相关动脉的分布特点,评价心电图诊断梗死相关动脉的价值。方法对132例急性心肌梗死患者心电图和冠状动脉造影资料进行回顾性比较分析。结果心电图显示心肌梗死发生率以心脏下壁、前间壁和广泛前壁最高,分别为31例(23.5%)、26例(19.7%)和22例(16.7%);造影显示梗死相关动脉的发生率分别为左主干(LM)3例(2.3%)、前降支(LAD)73例(55.3%)、回旋支(LCX)18例(13.6%)、右冠状动脉(RCA)38例(28.8%);前壁心肌梗死(55例)的梗死相关动脉多为LAD(51例,92.7%),下壁心肌梗死(31例)的梗死相关动脉多为RCA(22例,71.0%)或LCX(7例,22.6%),且与冠状动脉优势类型密切相关,前壁梗死合并aVR、aVL导联ST段抬高对诊断LAD近段闭塞的特异性较高,分别为86.7%和90.0%。结论急性心肌梗死心电图表现与梗死相关动脉存在明显相关性,有较高的临床诊断价值。     

右冠状动脉与左回旋支闭塞心肌梗死患者的临床对比分析

目的:对比分析右冠状动脉(RCA)与左回旋支(LCX)闭塞的急性下壁心肌梗死患者的心电图特征、心功能和预后。方法:90例首次急性下壁心肌梗死患者,进行常规心电图及冠状动脉造影。RCA闭塞组(RCA组)63例,LCX闭塞组(LCX组)27例,所有患者均在发病24 h内行直接冠状动脉介入术。术后2周行99mTc-MI-BI心肌灌注断层显像测定心肌梗死面积,并行心血池显像测定左室射血分数(LVEF)。观察住院期间心律失常、心力衰竭或心源性休克的发生率及病死率。结果:①RCA组下壁并右室梗死的发生率显著高于LCX组(P<0.01),而并发侧壁梗死的发生率显著低于LCX组(P<0.01)。②RCA组Ⅲst↑>Ⅱst↑及aVL st↓>Ⅰst↓的发生率也显著高于LCX组(P<0.01)。③RCA组肌酸激酶同工酶峰值及心肌梗死面积均大于LCX组(P<0.05)。④RCA组LVEF低于LCX组(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大,心功能和预后差。     

AMI行直接与择期PTCA及冠状动脉内支架术中再灌注性心律失常的比较

目的对比直接与择期PTCA及冠状动脉内支架术中再灌注性心律失常的发生率及术后心肌功能的恢复。方法 63例行介入治疗的急性心肌梗死患者,随机分为AB两组。A组44例行择期PTCA加STENT术(经皮冠状动脉腔内成形加支架术);B组19例行直接PTCA加STENT术。术中分别应用CAG(冠状动脉造影术)定位IRA(梗塞相关动脉),多导心电生理仪观察再灌注性心律失常,根据不同的心律失常类型予以相应的处理。术后10～20d两组病人均做超声心动图,对比LVEF(左心室射血分数)以评价心肌功能恢复的情况。结果 (1)首次CAG显示A组IRA51支,其中左前降支(LAD)29支,右冠状动脉(RCA)15支,左回旋支(LCX)7支;B组IRA 24支,其中LAD 13支,RCA 7支,LCX 4支。两组冠状动脉分支梗塞率相比无显著差异(P>0.05)。(2)A B两组行PTCA加STENT术中再灌注性心律失常发生率,A组为25％(11/44),其中心室颤动发生率为14％(6/44);B组为79％(15/19),其中心室颤动发生率为53％(10/19)。两组再灌注性心律失常的发生率及心室颤动发生率相比均有显著性差异(P<0.05)。两组心室颤动病人行电除颤后均转复为窦性心率。(3)病人住院10～20d,二维超声心动图显示,LVEF达到或超过60％者。A组为64％(28例),B组为89％(17例)。两组相比有显著性意义(P<0.05)。结论 直接PTCA加STENT术     

急性心梗再灌注心律失常的特点及阿托品前处理的影响

目的本实验通过对急性心肌梗死再灌注治疗（急诊PCI）致再灌注心律失常发生率的研究，为临床对再灌注心律失常的预防及治疗提供依据。通过急性下壁心肌梗死急诊PCI术前应用阿托品，了解阿托品对窦性心动过缓、窦性停搏或窦房阻滞等缓慢性再灌注心律失常发生率的影响及临床意义。方法选取急性前壁和下壁心肌梗死就诊的患者共252例。对发病12小时内进行PCI术的患者根据急性下壁、前壁心肌梗死进行分组。分别计算出二组再灌注心律失常的发生类型及发生率。急性下壁心肌梗死患者92例，配对分成二组：一组冠脉开通前予阿托品1mg静推；另一组不予任何药物干预。分别观察二组再灌注心律失常的发生率。结果急性前壁心肌梗死室性心律失常发生71例次，严重缓慢性心律失常发生13例次；急性下壁心肌梗死实验组严重缓慢性心律失常发生15例次，室性心律失常发生12例次；对照组严重缓慢性心律失常发生33例次，室性心律失常发生9例次。结论急性前壁心肌梗死患者室性心律失常发生率显著高于急性下壁心肌梗死患者（P〈0．01）；急性下壁心肌梗死患者严重缓慢性心律失常发生率显著高于急性前壁心肌梗死患者（P〈0．01）。阿托品前处理的急性下壁心梗患者严重缓慢性心律失常发生率显著低于未经阿托品前处理的急性下壁心肌梗死患者（P〈0．01）。     

心电图检查在急性心肌梗死靶血管定位中的应用

目的 观察心电图（ECG）检查在急性心肌梗死（AMI）靶血管定位中的应用.方法 将经明确诊断为AMI的274例患者按ECG的ST段抬高与否分为急性ST段抬高心肌梗死（STEMI） 186例与急性非ST段抬高心肌梗死（NSTEMI）88例,计数两组病例中ECG与冠脉造影（GAG）阳性病例数,比较ECG定位与CAG检查结果,比较两组CAG结果,并进行统计学分析.结果 274例患者中,CAG阳性者267例,其中ECG有改变者245例,CAG阴性者7例,其中ECG有改变者5例.ECG诊断AMI的检出阳性率为89.4％,敏感性为90.3％,特异性为42.9％.ECG定位梗死部位为广泛前壁39例,经CAG检查病变部位为左前降支（LAD）6例、右冠脉（RCA） ＋LAD5例、LAD＋左回旋支（LCX）13例、RCA ＋LCX2例、多支病变13例;EGG定位梗死部位为正前壁46例,经CAG检查病变部位为LAD 12例、RCA＋ LAD 1例、LAD＋ LCX 13例、多支病变20例;ECG定位梗死部位为前侧壁34例,经CAG检查病变部位为RCA2例、LAD14例、LCX3例、RCA ＋LAD 2例、LAD ＋LCX 5例、多支病变8例;ECG定位梗死部位为前间壁13例,经CAG检查正常2例、病变部位为LAD2例、LCX2例、RCA＋ LAD 2例、LAD ＋LCX 1例、多支病变4例;ECG定位梗死部位为下壁51例,经GAG检查正常2例、病变部位为RCA 16例、LCX6例、RCA ＋LAD 7例、RCA ＋LCX4例、多支病变16例;ECG定位梗死部位为下侧壁45例,经GAG检查病变部位为RCA6例、LCX9例、RCA ＋LAD 6例、RCA ＋LCX 6例、多支病变18例.与NSTEMI组比较,STEMI组单支病变比例高（P＜0.05）,侧支循环及慢性钙化闭塞性病变比例低（P＜0.01）.结论 ECG对于AMI靶血管的判断具有较好的提示作用,可用于初步判断AMI病变的靶血管.     

急性ST段抬高型心肌梗死经皮冠状动脉介入治疗术中再灌注心律失常的临床特点

目的观察急性sT段抬高型心肌梗死行经皮冠状动脉介入治疗（PCI）术中再灌注心律失常发生特点,提高救治成功率。方法对188例急性sT段抬高型心肌梗死患者在12小时内行急诊PCI,根据梗死相关动脉,分为前降支组、回旋支组及右冠状动脉组,观察3组再灌注心律失常发生情况,分析再灌注心律失常与梗死相关动脉的关系,了解冠脉再通时间对再灌注心律失常的影响。结果185例患者中185例成功植入支架。其中完全闭塞156例,次全闭塞或部分再通者32例,共发生再灌注心律失常75例,右冠状动脉组缓慢心律失常发生率高于前降支组和回旋支组,而快速心律失常发生率低于前降支组、回旋支组,但无统计学差异。开通时间越早,再灌注心律失常发生率越高,〈4小时组的快速心律失常发生率、缓慢心律失常发生率均大于4～8小时组、〉8小时组。结论直接PCI治疗开通梗死相关血管率高,是治疗急性心肌梗死的有效方法;随着血管的开通,可以发生再灌注心律失常,4小时内开通者发生再灌注心律失常高,右冠状动脉心肌梗死更容易发生缓慢性心律失常,只要及时处理,再灌注心律失常预后良好。     

急诊PCI术中再灌注心律失常的研究

目的探讨急性心肌梗死患者急诊行经皮冠状动脉介入术(PCI)中再灌注心律失常(RA)的临床特点。方法回顾性分析125例急性心肌梗死且急诊行PCI术治疗患者的临床资料。观察分析再灌注心律失常与梗死相关动脉(IRA)开通所需时间、IRA是否完全闭塞及梗死面积大小的之间的关系。结果 125例患者中85例发生RA(68%)。梗死6h内开通冠状动脉者再灌注心律失常发生率明显高于6～12h开通者(p<0.05)。完全闭塞组RA发生率总体发生率均显著高于次全闭塞组RA发生率(p<0.05)。广泛前壁心肌梗死与局限性心肌梗死RA的发生率无统计学差异(p>0.05)。结论 AMI患者直接PCI后RA发病率及严重程度与IRA病变程度、发病至开通IRA时间明确相关,与梗死面积无关。     

初次急性ST段抬高型心肌梗死再灌注心律失常发生的时间和特点

目的探讨紧急血运重建治疗初次ST段抬高型心肌梗死(STEMI)患者开通梗死相关动脉(IRA)后发生再灌注心律失常(RA)的发生时间和特点。方法选择2006年1月至2012年1月初次患急性STEMI入院行急诊冠状动脉介入治疗(直接PCI)开通IRA的326例患者,男216例,女110例,年龄37～81〔平均(61.7±9.2)〕岁。从发病到球囊扩张时间为(3.0～7.5)h。观察球囊扩张开通IRA并出现前向血流TIMI 2级或2级以上时到出现RA的时间、RA发生率、RA的类型和持续时间;RA与IRA的关系。结果 326例STEMI患者直接PCI成功达100%,其中272例(83.4%)发生了RA。IRA血管开通到RA出现的时间为5～69 s,平均(21.8±13.9)s;持续时间30 s～12 min,平均(5.6±4.7)min;右冠脉IRA者159例中156例发生RA(98.1%);前降支(LAD)为IRA 112例,发生RA 72例(64.3%);左回旋支(LCX)为IRA 55例,发生RA 44例(80.0%)。RCA和LCX为IRA 214例,发生缓慢型RA为93.5%;LAD为IRA 112例中,发生快速型RA 72例(64.3%)。结论对于无侧支循环的STEMI直接PCI开通IRA后发生RA是一种较常见的并发症,其总的发生率为83.4%。IRA为RCA和LCX者的RA主要是缓慢性心律失常,IRA为LAD者主要发生快速性心律失常。     

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。     

急性心肌梗死再灌注心律失常的分布特征及其与自主神经失衡的关系

目的:观察急性ST段抬高型心肌梗死（STEMI）患者自主神经活性及再灌注心律失常（RA）特点，探讨自主神经在急性STEMI再灌注心律失常的作用及机制。方法:冠状动脉造影证实梗死血管完全闭塞的患者，12 h内完成急诊冠状动脉介入（PCI）治疗的108例，根据梗死相关动脉分组，以梗死后心率、血压情况，评估自主神经活性。分析RA分布特征及与自主神经失衡的关系。结果: RA总发生率为44%，右冠状动脉组RA发生率显著高于其他部位（65% vs. 35%和33%，P<0.01),距开通时间愈短RA发生率愈高(P<0.05,P<0.01)。前降支组交感神经过度激活者增多，右冠状动脉组迷走神经过度激活者增多，两组有显著性差异。结论:STEMI梗死再灌注RA总发生率为44%，右冠状动脉发生率显著高于其他部位，距开通时间愈短发生率愈高，且RA与自主神经失衡有关。     

Relation between electrocardiography and coronary angiography findings in the infarct stage

One hundred and fifty-two patients underwent cardiac catheterization and coronary arteriography within 6.3 +/- 6.0 hours from onset of acute myocardial infarction. All had a standard 12-lead electrocardiogram recorded within 1.5 hours of cardiac catheterization. The electrocardiographic abnormalities present were correlated with the infarct related artery as determined by coronary arteriography. ST segment elevation was the most common finding in patients with the left anterior descending (LAD), or right coronary artery (RCA) as the infarct related artery. ST segment depression was the most common abnormality in patients with left circumflex artery (CX) as the infarct related artery. A typical pattern of anterior acute myocardial infarction was seen in 93% of all patients with the LAD as the infarct related artery. A typical pattern of acute inferior myocardial infarction was seen in 53% of all patients with RCA or CX narrowing taken as one group. The pattern of true posterior or posterolateral wall acute myocardial infarction in the absence of typical changes in the inferior leads was highly specific and predictive of CX narrowing. In contrast, the pattern of an inferior wall myocardial infarction, in the absence of true posterior or lateral wall changes, was highly specific and predictive of right coronary artery narrowing. Fifty-six percent of patients with CX artery as the infarct related artery presented with non-classical electrocardiographic abnormalities. The electrocardiographic pattern in patients with subtotal occlusions were similar to those of patients with total occlusions. Thus the electrocardiogram obtained in the first few hours of acute myocardial infarction is reliable in localizing the LAD as the infarct related artery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multiple coronary artery thrombosis in a 41-year-old male patient presenting with ST-segment elevation myocardial infarction

Simultaneous occlusion of multiple epicardial coronary arteries is an uncommon finding in patients presenting with ST-segment elevation myocardial infarction (STEMI). We describe a 41- year-old male Asian patient who presented with inferior and anterior STEMI complicated by cardiogenic shock and frequent life-threatening ventricular arrhythmias. The patient was subsequently found to have acute occlusion of the proximal right coronary artery (RCA) and proximal left anterior descending coronary artery (LAD). The patient was treated with primary percutaneous coronary interventions for RCA and LAD, and intra-aortic balloon pump placement showed excellent results. Based on the available literature, early PCI for this very rare condition is paramount for patient survival.     

Reperfusion arrhythmias in acute myocardial infarction]

Twenty-seven patients with acute myocardial infarction (AMI), in whom infarct-related coronary artery was occluded and thrombolytic therapy or PTCA were performed, were studied. Reperfusion confirmed by immediate coronary angiography was achieved in 24 patients. Reperfusion arrhythmias (RA) occurred in 19(79.2%) of the patients, including ventricular arrhythmias in 13 (54.2%). Ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) developed in 2(8.4%), and accelerated idioventricular rhythm in 5(20.8%); the latter showed a reliable indicator of coronary artery recanalization. Transient sinus bradycardia or AV block occurred in 10 (66.7%) of the 15 patients with inferior-posterior MI, which was an indicator of recanalization of coronary artery and salvage of myocardium in inferior-posterior MI. The occurrence of RA was not correlated with the duration of ischemia; ventricular RA was not related to the location of AMI and the occurrence and severity of ischemic arrhythmias before reperfusion. The patients with RA were treated with ordinary antiarrhythmic therapy, VF and sustained VT in 2 patients were converted by electric defibrillation. No death related to RA occurred. RA couldn't be prevented by lidocaine.     

急性心肌梗死经皮冠状动脉介入术中心律失常及处理

目的比较分析因急性心肌梗死接受经皮冠状动脉介入术病人的心律失常特点以及处理策略。方法观察209例急性心肌梗死病人在直接经皮冠状动脉介入术中心律失常的类型以及在不同的干预血管：右冠状动脉、左前降支和左回旋支中的发生机会。结果209例急性心肌梗死患中共出现86例心律失常，其中右冠状动脉病变27例，左前降支病变44例，左回旋支病变18例，共出现窦性心动过缓14例，共出现室性心律失常51例。结论右冠状动脉病变的病人术中发生的窦性心动过缓比其他血管病变多；室性心律失常在接受直接经皮冠状动脉介入术治疗的急性心肌梗死病人中多见：应积极防治在急性心肌梗死直接经皮冠状动脉介入术中出现的各种严重心律失常。     

Coronary anatomy and left ventricular function in the first 12 hours of acute myocardial infarction: the Western Washington Randomized Intracoronary Streptokinase Trial

The relationships among clinical variables, coronary anatomy, and left ventricular function during the early hours of acute myocardial infarction (AMI) were evaluated from data acquired in the Western Washington Intracoronary Streptokinase Trial. All patients had symptoms and electrocardiographic changes typical of AMI. All data were obtained before treatment with streptokinase. Mean time to catheterization was 4.1 hr after onset of symptoms. Coronary angiograms (n = 245) were analyzed for location of infarct-related occlusion and collateral flow to the infarct bed. Left ventricular ejection fraction and regional left ventricular function were quantitated in 227. Sixty-two percent of occlusions were in the most proximal segment of the involved coronary artery. Collateral circulation was seen in 42% overall, in 31% with left anterior descending artery (LAD) occlusion, and in 52% with right coronary artery (RCA) occlusion (p less than .005). Left ventricular ejection fraction was lowest and regional function was most abnormal in the group with proximal LAD occlusion. Hyperkinesis was present in 32%; in those with hyperkinesis, hyperkinetic segment length was longest in those with RCA or circumflex occlusion. Multivariate analysis identified proximal LAD occlusion as the factor most closely associated with left ventricular ejection fraction and with measures of left ventricular regional hypofunction. We conclude that (1) AMI is usually caused by occlusion or subtotal occlusion in the most proximal portion of the involved coronary artery, (2) collateral circulation is more frequent with RCA than with LAD occlusion, and (3) location of the infarct-related occlusion is the most important determinant of global and regional left ventricular function in the early hours of AMI.     

High dose intravenous streptokinase in acute myocardial infarction--short and long term prognosis.

Streptokinase (1 million international units) was given intravenously over 30 or 60 minutes to 50 patients four hours or less after the onset of acute myocardial infarction. All were aged less than or equal to 70 years and had 4 mm or greater ST segment elevation in anterior or inferior leads. Rapid (mean 95 min) ST segment resolution, which was taken to indicate reperfusion of the myocardium, occurred in 36 (72%) patients. In these 36 the average time from onset of symptoms to peak creatine kinase, creatine kinase MB, and myoglobin was 9.45 hours, whereas it was 17 hours in the 14 patients in whom indirect criteria did not indicate reperfusion. Reperfusion arrhythmias were invariably present and ventricular tachycardia developed in five patients and ventricular fibrillation in two. The infarct related artery was seen to be open in 28 (70%) of the 40 patients who had delayed coronary arteriography. The frequency of patency in the infarct related artery was no different in patients given streptokinase less than 2 hours or between 2-4 hours from onset of symptoms nor did it differ when streptokinase was infused over 30 or 60 minutes. Mean left ventricular ejection fraction was 57% in those with a patient infarct related artery and 48% in those with an occluded vessel. Eight patients subsequently underwent elective percutaneous transluminal coronary angioplasty after successful thrombolysis and six had coronary artery bypass grafting. There were nine in-hospital reocclusions of the infarct related coronary arteries. Two bleeding episodes occurred; one required transfusion. Five of the 50 patients died in hospital. All of them had had an anterior myocardial infarction; four had bifascicular block and one had right bundle branch block. During follow up, four patients died, two suddenly and two from reinfarction. During follow up (mean 15 months) the frequency of reinfarction, dyspnoea, and angina was low and there was no difference in the proportions of patients returning to work between those with an open infarct related artery and those with a closed infarct related artery. Intravenous administration of high dose streptokinase to selected patients during the acute phase of myocardial infarction is a safe, effective, and practical method of thrombolysis. It must, however, be followed by coronary arteriography to select those patients in whom percutaneous transluminal coronary angioplasty or coronary artery bypass grafting will be helpful.     

High dose intravenous streptokinase in acute myocardial infarction--short and long term prognosis

Streptokinase (1 million international units) was given intravenously over 30 or 60 minutes to 50 patients four hours or less after the onset of acute myocardial infarction. All were aged less than or equal to 70 years and had 4 mm or greater ST segment elevation in anterior or inferior leads. Rapid (mean 95 min) ST segment resolution, which was taken to indicate reperfusion of the myocardium, occurred in 36 (72%) patients. In these 36 the average time from onset of symptoms to peak creatine kinase, creatine kinase MB, and myoglobin was 9.45 hours, whereas it was 17 hours in the 14 patients in whom indirect criteria did not indicate reperfusion. Reperfusion arrhythmias were invariably present and ventricular tachycardia developed in five patients and ventricular fibrillation in two. The infarct related artery was seen to be open in 28 (70%) of the 40 patients who had delayed coronary arteriography. The frequency of patency in the infarct related artery was no different in patients given streptokinase less than 2 hours or between 2-4 hours from onset of symptoms nor did it differ when streptokinase was infused over 30 or 60 minutes. Mean left ventricular ejection fraction was 57% in those with a patient infarct related artery and 48% in those with an occluded vessel. Eight patients subsequently underwent elective percutaneous transluminal coronary angioplasty after successful thrombolysis and six had coronary artery bypass grafting. There were nine in-hospital reocclusions of the infarct related coronary arteries. Two bleeding episodes occurred; one required transfusion. Five of the 50 patients died in hospital. All of them had had an anterior myocardial infarction; four had bifascicular block and one had right bundle branch block. During follow up, four patients died, two suddenly and two from reinfarction. During follow up (mean 15 months) the frequency of reinfarction, dyspnoea, and angina was low and there was no difference in the proportions of patients returning to work between those with an open infarct related artery and those with a closed infarct related artery. Intravenous administration of high dose streptokinase to selected patients during the acute phase of myocardial infarction is a safe, effective, and practical method of thrombolysis. It must, however, be followed by coronary arteriography to select those patients in whom percutaneous transluminal coronary angioplasty or coronary artery bypass grafting will be helpful.     

急性心肌梗死患者不同冠状动脉病变对介入术后预后的影响

目的探讨急性心肌梗死经皮冠状动脉介入治疗患者不同冠状动脉病变对预后的影响。方法将117例接受急诊经皮冠状动脉介入治疗的急性心肌梗死患者根据罪犯血管不同分为左前降支组51例、左回旋支组27例、右冠状动脉组39例。比较3组患者术后ST段回落〉70％的梗死相关导联数、TIMI血流分级、住院期间及出院后1年内主要心脏不良事件发生率。结果与左回旋支组和右冠状动脉组比较,左前降支组术后ST段完全回落的梗死相关导联数和左室射血分数显著降低（P〈0．05）,心源性死亡率及总主要心脏不良事件率显著升高（P〈0．05）。结论左前降支病变者术后心电图ST段回落更缓慢、左心功能不全更严重、主要心脏不良事件发生率更高、预后更差。