急性心肌梗死溶栓效果与冠脉造影特征分析

目的 探讨急性心肌梗死(AMI)患者静脉溶栓再灌注效果与冠状动脉病变影像学特征即冠脉病变支数、梗死相关动脉(infarct-related artery,IRA)分布部位、形态、狭窄程度与长度)的相关性.方法 收集2001年1月至2007年8月在广西医科大学第一附属医院心血管病研究所住院且行尿激酶静脉溶栓的84例AMI患者资料进行回顾性分析.采用单因素与多因素方法分析冠脉造影病变特征即病变支数、IRA分布部位、形态改变、狭窄程度和长度等因素与再通是否相关.结果 按间接再通指征判断再通率为64.29%.单因素检验显示IRA狭窄长度、及分布部位,均进入回归方程(P值均＜0.05),病变支数及IRA狭窄程度未能进入回归方程(P＞0.05).多因素logistic回归分析结果提示尿激酶溶栓再通与IRA狭窄长度患者呈负相关;与IRA分布部位相关性无统计学意义(P＞0.05).结论 (1)AMI患者静脉尿激酶溶栓再通效果与IRA狭窄长度呈负相关;(2)冠脉病变支数、IRA分布部位及IRA狭窄程度等因素与再通效果无统计学意义相关性.

Abstract：

Objective To evaluate the angiographic findings and the therapeutic effect of thrombolysis in AMI (acute myocardial infarction) patients. Method A retrospective study were carried out in consecutive eighty-four inpatients with AMI treated with intravenous thrombolysis and coronary angiography was taken within a week after illness onset from January 2000 to August 2007. The patients were divided into successful recanalization group and non-recanalization group. Single factor χ2 test and multi-factor logistic regression analysis were applied to observe the relationship among the angiographic features of IRA (infarct-related artery including the number of stnosis, the location of stenosis, the severity of stenosis and the morphological changes) and treatment effect of intravenous urokinase thrombolysis. Results (1) Single factor χ2 test showed that location and the extent of lesion of IRA were eligible to enter the logistic regression formula (P ＜ 0.05),whereas the number of lesions and the severity of IRA's stenosis were not eligible to enter the logistic regression formula (P ＞ 0. 05). (2) Multi-factor logistic regression analysis showed that the extent of lesion of IRA was the only factor that had a negative impact on the therapeutic effect of intravenous thrombolysis.Conclusions The study shows that the extent of lesion of IRA is the only factor that has a negative impact on the therapeutic effect of intravenous thrombolysis; The number, the location of lesion and the severity of stenosis of IRA have no impact on the therapeutic effect of intravenous thrombolysis in AMI.

Angiographic features of infarct-related artery and the therapeutic efficacy of intravenous thrombolysis in patients with acute myocardial infarction

Objective To evaluate the angiographic findings and the therapeutic effect of thrombolysis in AMI (acute myocardial infarction) patients. Method A retrospective study were carried out in consecutive eighty-four inpatients with AMI treated with intravenous thrombolysis and coronary angiography was taken within a week after illness onset from January 2000 to August 2007. The patients were divided into successful recanalization group and non-recanalization group. Single factor χ2 test and multi-factor logistic regression analysis were applied to observe the relationship among the angiographic features of IRA (infarct-related artery including the number of stnosis, the location of stenosis, the severity of stenosis and the morphological changes) and treatment effect of intravenous urokinase thrombolysis. Results (1) Single factor χ2 test showed that location and the extent of lesion of IRA were eligible to enter the logistic regression formula (P ＜ 0.05),whereas the number of lesions and the severity of IRA's stenosis were not eligible to enter the logistic regression formula (P ＞ 0. 05). (2) Multi-factor logistic regression analysis showed that the extent of lesion of IRA was the only factor that had a negative impact on the therapeutic effect of intravenous thrombolysis.Conclusions The study shows that the extent of lesion of IRA is the only factor that has a negative impact on the therapeutic effect of intravenous thrombolysis; The number, the location of lesion and the severity of stenosis of IRA have no impact on the therapeutic effect of intravenous thrombolysis in AMI.