临床诊断急性冠状动脉综合征与冠状动脉造影结果的对比分析

目的　探讨冠状动脉造影 (CAG)检查对临床初诊急性冠状动脉综合征 (ACS)患者的临床意义。方法　对 2 0例临床初诊ACS患者的CAG和心电图 (ECG)结果进行对比分析。结果　非冠状动脉狭窄引起的胸痛占 10 %。ECG诊断ACS患者冠状动脉病变阳性率为 80 %。ECG表现前壁缺血改变以左主干、左前降支及 3支血管病变为主 ;下壁缺血改变以右冠脉或右冠脉加回旋支及 3支血管病变为主。初发劳力型心绞痛以单支、轻度血管病变为主 ;恶化劳力型心绞痛以多支血管中、重度病变为主 ;静息心绞痛、非ST段抬高心肌梗死 (NSTEMI)以多支血管 (均有左主干 )、重度或完全血管闭塞病变为主 ;ST段抬高的心肌梗死 (STEMI)以多支、重度血管病变为主。对这些患者早期介入治疗 ,可降低心绞痛发作次数 ,改善临床近期预后 ,减少心肌梗死及死亡发生。结论　临床初诊ACS患者应尽早行CAG检查 ,对ACS患者早期正确诊断 ,了解病变血管部位、程度提供客观依据 ,以利于及时进行冠脉血运重建术。

Clinical significance of early coronary angiography for the diagnosis of acute coronary syndrome

Objective To study the importance of early coronary angiography(CAG) for the initial diagnosis,prognosis and treatment of acute coronary syndrome(ACS).Methods Total 20 patients with the diagnosis of ACS were included in the study.ECG and CAG were performed in all patients.Results 10% of patients with ACS had non-coronary disease as the cause of chest pain.80% of patients with coronary lesions by CAG had positive ECG changes.Patients with anterior wall lead changes had left main,left anterior descending branch of three vessels lesions;Patients with inferior wall lead changes had right coronary desease with or without circumflex or three vessels lesions.The patients with initial exertional angina had single,mild lesions;the patients with deteriorating exertional angina often had multiple vessels and moderate lesions.The patients with resting angina and non-ST elevation myocardial infarction(NSTEMI) had multiple vessel lesions(all had left main coronary involvement),severe or total occlusion of those vessels,while patients with ST elevation myocardial infarction(STEMI) had multiple vessel disease and more severe coronary lesions.Early intervention in these patients can decrease the recurrence of angina,improve prognosis,and lower incidence of myocardial infarction and mortality.Conclusion Patients with clinical diagnosis of ACS should undergo CAG.The procedure not only provides early correct diagnosis,elucidates the location of coronary lesions and severity of the lesions,but also provides information to facilitate the coronary arterial bypass graft.