梗死相关动脉完全闭塞的急性非ST段抬高型心肌梗死患者的临床特点

目的探讨梗死相关动脉(IRA)完全闭塞的急性非ST段抬高型心肌梗死(NSTEMI)患者的临床特点。方法连续入选症状发作24 h内行急诊冠状动脉造影、且IRA完全闭塞的急性NSTEMI患者42例,IRA位于前降支10例,左回旋支1 8例,右冠状动脉12例和中间支2例。分析IRA位于左回旋支、右冠状动脉和前降支的临床特点。结果与IRA位于非左回旋支系统比较,IRA位于左回旋支侧支循环良好比例少,冠状动脉造影前症状持续发作始终无明显减轻比例更高(P<0.05);IRA位于左回旋支主支血管的近段或中段侧支循环不良比例多(P<0.05)。与IRA位于非右冠状动脉系统比较,IRA位于右冠状动脉的非胸痛症状比例增多(P<0.05)。与IRA位于非前降支系统比较,IRA位于前降支患者T波倒置>0.2 mV比例增多(P<0.01)。结论位于不同部位的IRA完全闭塞的NSTEMI患者存在不同的临床特点;易被常规导联心电图漏诊的左回旋支闭塞,值得关注。

Clinical characteristics of acute non-ST-segment elevation myocardial infarction patients with total occlusion of infarct-related artery

Objective To investigate the clinical characteristics of acute non-ST-segment elevation myocardial infarction(NSTEMI) patients with total occlusion of infarct-related artery(IRA). Methods Consecutive 42 patients who had confirmed diagnosis of acute NSTEMI and experienced total occlusion of IRA detected by emergency angiography within 24 hours from the heart attack were enrolled.The clinical characteristics of these patients were stndied.Results In the patients whose IRA was circumflex artery,the proportion of good collateral circulation was lower compared with the patients whose IRA was anterior descending branch or right coronary artery(P<0.05).In the patients with IRA being circumflex artery,the proportion of cases whose symptoms were persistent and were not alleviated before angiography was greater compared with other patients(P<0.05).The proportion of patients with IRAs being right coronary artery,whose symptoms were not chest pain,was greater than the other patients(P<0.05).Conclusion If classification was according to different IRAs,the acute NSTEMI patients with total occlusion of IRA have different characteristics.The total occlusion of circumflex artery which is apt to be missed by the standard ECG is worthy of attention.