心绞痛对急性心肌梗塞后心脏功能影响的临床研究

目的:探讨心绞痛对急性心肌梗死后心脏功能的影响。方法:选择行冠状动脉造影和左室造影的252例首次急性心肌梗死患者,分组比较既往心绞痛及梗死前心绞痛对肌酸激酶(CK)峰值浓度、冠状动脉侧支循环和左室功能等的影响。结果:252例患者中,兼有既往心绞痛和梗死前心绞痛者46例(A组,占18.3%),单纯既往心绞痛者112例(B组,占44.4%),单纯梗死前心绞痛者43例(C组,占17.1%),梗死前无心绞痛者51例(D组,占20.2%);CK峰值浓度:A组显著低于D组(P<0.05);肌酸激酶同工酶(CK-MB)的峰值浓度:A组显著低于D组(P<0.01)和B组(P<0.05),B组和C组均低于D组(P均<0.05)。非Q波心梗的比率:A组显著高于D组(35%与16%,P<0.05)。冠状动脉侧支循环:有既往心绞痛的A、B组明显好于既往无心绞痛的C、D组(P<0.05)。左室射血分数:A组显著高于其他各组,而且B组和C组均高于D组(P<0.05)。室壁运动(Cortina计分):A组明显低于其他各组,B组和C组均显著低于D组(P<0.05)。结论:既往心绞痛促进冠状动脉侧支循环的建立,梗死前心绞痛可能导致缺血预适应的产生,二者协同对急性心肌梗死后的心脏功能起保护作用。

The Effects of Angina Pectoris on Cardiac Function in Patients with Acute Myocardial Infarction

Objective:To investigate the effects of previous and/or prodroma angina pectoris(AP) on cardiac function in patients with acute myocardial infarction.Method:252 patients with first acute myocardial infarction underwent selective coronary angiography and left ventriculography.The relation of previous AP and prodroma AP to peak creatine kinase,coronary collateral circulation and left ventricular function were analyzed separately.Result:In the 252 patients,there were 46 cases with both previous and prodroma AP(group A,18.3%),112 cases with solely previous AP(group B,44.4%),43 cases with solely prodroma AP(group C,17.1) and 51 cases without any angina(group D,20.2%).The peak creatine kinase was significantly lower in group A than that in group D(P<0.05),and the peak creatine kinase MB fraction was significantly lower in group A than those in group B and D(P<0.01 and <0.05,respectively).The peak creatine kinase MB fractions in group B and C were significantly lower than that in group D(P<0.05,for both comparisons).The ratio of non Q wave myocardial infarction was significantly higher in group A than that in group D(35% vs 16%,P<0.05).The coronary collateral circulation in group A and B was much better than that in group C and D(P<0.05 for each comparison).The left ventricular ejection fraction(LVEF) was higher in group A than those in the other groups(P<0.05 or 0.01).The LVEFs in group B and C were significantly higher than that in group D.The left ventricular wall motion cortina score was lower in group A than those in the other groups(P<0.05 or 0.01).Conclusion:By different mechanisms,previous and prodroma angina pectoris could synergetically protect the cardiac function in patients with acute myocardial infarction.