急性下壁心肌梗死合并完全性房室阻滞患者冠状动脉病变的特点及临床预后

目的:探讨急性下壁心肌梗死合并完全性房室阻滞(CAVB)患者的冠状动脉病变特点及早期预后.方法:对发病12小时内急诊直接经皮冠状动脉腔内成形术且梗塞相关血管为右冠状动脉的急性下壁心肌梗死患者139例,按经皮冠状动脉腔内成形术前是否出现CAVB分为CAVB组(n=35)和无完全性房室阻滞(NAVB)组(n=104),进行临床、冠状动脉造影、心功能及早期预后分析.结果:经皮冠状动脉腔内成形术前梗塞相关血管闭塞(TIMl 0～1级)率CAVB组高于NAVB组,有显著性差异(P＜0.05);CAVB组多支病变、无有效侧支循环、严重心律失常(室性心动过速、心室颤动)发生率均高于NAVB组,有极显著性差异(P＜0.01);肌酸激酶峰值、合并右心室梗死及院内病死率CAVB组高于NAVB组,均有显著性差异(P＜0.05).多因素分析完全性房室阻滞不是院内死亡的独立危险因素.结论:急性下壁心肌梗死发生的完全性房室阻滞,与梗死区域的残余血流(前向血流与侧支血流)减少及多支冠状动脉病变有关,合并完全性房室阻滞者即使介入治疗成功仍有较高的病死率,应给予更积极的治疗和严密监测.

Angiographic Findings and Clinical Outcomes of Complete Atrioventricular Block Complicating Acute Inferior Myocardial Infarction

Objective:To investigate the prognostic importance of complete atrioventricular block(CAVB) complicating acute inferior myocardial infarction(AIMI).Methods:Primary percutaneous transluminal coronary angioplasty (PTCA) was performed in 139 patients with acute inferior myocardial infarction due to right artery lesions.The patients were divided according to the presence (CAVB group ) or absence (NAVB group ) of CAVB.Results:The in-hospital mortality in CAVB group was significantly higher than NAVB group(17.1% vs 4.8%,p <0.01),though the success rate of PTCA was similar in the two groups.The coronary angiographic findings revealed that CAVB group had a poorer TIMI flow and poorer collateral circulation to the infarction-related arteries.However it had a higher frequency of multivessel diseases.Conclusion:Patients with acute inferior MI are at increased risk of CAVB.The mechanism may be associated with the poorer residual flow in the infarcted regions and multivessel diseases.