急性心肌梗死发病时间与梗死相关冠状动脉病变特点

目的通过冠状动脉造影了解急性心肌梗死患者冠脉病变特点,探讨其病变特点与发病时间关系。方法回顾分析因急性ST段抬高型心肌梗死住院行常规药物治疗,于发病2周后接受冠脉造影加支架术患者83例,根据其发病时间将患者分为二组：上午组（6：01-12：00,n=52）、其他时间组（12：01-次日06：00,n=31）,由两名医师双盲进行心电图及冠状动脉造影光盘阅读和测量,结合心电图及冠脉造影明确梗死相关血管病变特点,包括部位、梗死血管病变形态、类型及狭窄程度,进行统计学分析。结果上午组、其他时间组间梗死相关血管部位差异无统计学意义（P〉0.05）;偏心性病变上午组较其他时间组显著多见（P〈0.0125）,同心型、复杂型病变二组间差异无统计学意义（P〉0.0125）;而血栓性病变二组间差异无统计学意义（P〉0.05）;A型病变上午组较其他时间组显著多见（P〈0.0125）,B型病变、C型病变二组间差异无统计学意义（P〉0.0125）;冠脉病变狭窄程度二组间差异无统计学意义（P〉0.05）。结论急性心肌梗死相关血管中,A型病变及偏心狭窄病变与发病时间有关且多发生于晨起及上午。

Relationship Between Characteristics of Culprit Artery and Onset Time in Patients with Acute Myocardial Infarction with PCI

Objective To study the relationship between characteristics of infarct-related artery and onset time in patients with acute myocardial infarction （AMI） with percutaneous coronary intervention （PCI）.Methods Eighty-three STEAMI patients who were treated with normal medical therapy at the beginning of onset and PCI in the later 10～14 days were reviewed.They were divided into two groups according to their symptom onset time：forenoon group （06：01～12：00,n=52） and other time point group （12：01-06：00 next day,n=31）.In the use of ECG and disks of Coranary Agiogram,the characteristics of culprit artery pathological changes such as position,pattern,type and stenosis in all the patients were detected double-blindly by two doctors.Results The incidence of A type and partial stenosis pathological changes in the culprit artery in forenoon group was higher than that in other time point group （P0.0125）.However,infarction position and the incidence of thrombosis pathological changes in the culprit artery and the degree of coronary artery stenosis showed no statistically significant difference between the two groups （P0.05）.At the same time,the incidence of B type,C type,concentric stenosis,and complicated pathological changes showed no statistically significant difference in the culprit artery between the two groups （P0.0125）.Conclusion：The results show that there may exist a relationship between A type and partial stenosis pathological changes in culprit artery and onset time in patients with acute myocardial infarction.The incidence of AMI with the two pathological changes in culprit artery may be higher in the early and late morning.