心电图正常范围急性心肌梗死冠状动脉造影和心肌酶特点

目的研究心电图始终处于正常范围的急性心肌梗死病例冠状动脉造影和酶学检查的特点,以减少急性心肌梗死的漏诊。方法选择2005年3月至2011年3月临床确诊为急性心肌梗死的病例574例,按照是否有ST段抬高分为ST段抬高组和心电图正常组,分析比较两组冠状动脉造影和酶学检查的特点。结果心电图正常组81例,ST段抬高组493例,两组冠状动脉造影比较,病变血管在左主干(LM)、右冠状动脉(RCA)有显著差异(P<0.05,P<0.01);酶学检查肌钙蛋白(cTnI)、肌酸激酶(CK)有差异(P<0.05)。结论心电图始终处在正常范围的急性心肌梗死,其特点是冠状动脉造影检查呈多支病变,不易发生左主干梗死,酶学检查数值升高的程度低于ST段抬高型急性心肌梗死。

Characteristics of coronary artery angiography and myocardial enzyme in acute myocardial infarction with normal electrocardiogram

Objective To investigate the characteristics of coronary artery angiography and myocardial enzyme among the cases with acute myocar- dial infarction but normal electrocardiogram, and reduce the missed diagnosis of acute myocardial infarction. Methods 574 cases with diagnosis of acute myocardial infarction from March 2005 to March 2011 participated in the study, and were divided into the groups of normal electrocardiogram and elec- trocardiographic ST segment elevation. The characteristics of coronary artery angiography and myocardial enzyme were compared between the two groups. Results There were 81 cases with normal electrocardiogram and 493 cases with ST segment elevation. Between the two groups, vascular lesion on left main coronary artery （LM） and right coronary artery （RCA） had significant difference in coronary artery angiography （ P 〈 0.05）, and tro- ponin （cTnl） and creatine kinase （CK） had signficant difference in the tests of myocardial enzyme （ P 〈 0.01）. Conclusion The cases with normal elec- trocsxdiogram had more multivessel disease, less infarction on the left main coronary artery in the tests of coronary artery angiography, and higher value in the tests of myocardial enzyme than the cases with ST segment elevation.