老年急性心肌梗死心电图墓碑型改变的相关血管及临床意义

目的 探讨老年患者急性心肌梗死（AMI）心电图墓碑型改变的相关血管及临床意义.方法 回顾性分析我院心内科2011年6月至2013年6月行冠脉造影检查的364例AMI患者资料,根据心电图ST段改变选取96例患者,分为墓碑型改变组（46例）和非墓碑型改变组（50例）,根据年龄将墓碑型改变组分为墓碑改变老年组（26例）和墓碑改变非老年组（20例）,分析三组的相关冠状动脉及临床并发症情况.结果 三组患者的一般情况差异无统计学意义.与非墓碑型改变组相比,墓碑型改变组病变血管多位于前降支近端（老年组80.8%比75.0%,P〈0.01;非老年组80.8%比36.0%,P〈0.01）,且合并右冠状动脉或左回旋支病变,墓碑改变老年组的相关血管多为双支或三支病变.与其他两组相比,墓碑型老年组的死亡率高（33.3%比5.0%,P〈0.01;33.3%比4.0%,P〈0.05）.结论 急性心肌梗死心电图墓碑型改变的老年人有较严重的血管病变、较高的死亡率及临床并发症.

The related artery and clinical significance of tombstone of electrocardiogram in elderly patients with acute myocardial infarction

Objective To investigate the related artery and clinical significance of tombstone of electrocardiogram in elderly patients with acute myocardial infarction. Methods Retrospective analysis of 364 patients un- derwent coronary anglography from June 2011 to June 2013 in the department of cardiology in our hospital. Accord- ing to ST-segment changes, we selected 96 patients, which was divided into tombstone changing group （46 cases） and non Tombstone changing group （50 cases）. According to age, tombstone change group was divided into elderly group （26 eases） and non-elderly group （20 cases）, the related coronary and clinical complications among three groups were analyzed. Results There was no significant difference in general case among the three groups. Compared with non tombstone changing group, the coronary lesion of tombstone changing group were located in the proximal of left anterior descending artery, which combined the right coronary or left circumflex artery （80.8% vs 75.0%, P〈0.01,80.8% vs 36.0%, P〈0.01 ）, and the related artery of tombstone changing older group was usually double branch or three lesions. Compared with the other two groups, tombstone changing older group have a high mortality （33.3% vs 5.0%, P〈0.01,33.3% vs 4.0%, P〈0.05）. Conclusion The elderly patients with acute myocardial infarction who have tombstone of electrocardiogram have a higher vascular disease, mortality and clinical complications.