急性心肌梗死合并三度房室传导阻滞的预后及再灌注治疗的意义

目的分析急性心肌梗死合并三度房室传导阻滞(Ⅲ°AVB)患者的临床特征,探讨再灌注治疗对急性心肌梗死合并Ⅲ°AVB预后的意义。方法1992年~2005年连续入院的急性心肌梗死合并Ⅲ°AVB患者51例(Ⅲ°AVB组),每组选择前后相继入院的急性心肌梗死患者2例,共102例构成非Ⅲ°AVB组。比较两组基线临床资料、住院期间死亡率、并发症,以及再灌注治疗的差异。观察Ⅲ°AVB组12h内有效再灌注治疗的病例和未能再灌治疗的病例住院期间的转归。结果(1)与非Ⅲ°AVB组比较,Ⅲ°AVB组发病年龄较大,下壁或右心室梗死比例高,住院期间死亡、心室颤动、KillipⅣ级心功能、心源性休克发生率高,需要起搏治疗的例数多,两组差异有统计学意义。(2)Ⅲ°AVB组排除既往有心肌梗死史及合并其他全身疾病的病例5例,其余46例,17例发病12h内再灌注治疗,住院期间死亡1例,29例未再灌注治疗,死亡12例,P<0.02.。结论急性心肌梗死合并Ⅲ°AVB预后差,住院期间死亡率高。12h内再灌注治疗患者住院期间死亡例数相对较少,这种预后的差异是否有普遍意义,还需进一步研究。

Role of reperfusion therapy in patients with complete atrioventricular block complicating acute myocardial infarction

Objective The aim of this study was to investigate the role of reperfusion therapy in complete atrioventricular block (CAVB) complicating acute myocardial infarction (AMI). Methods Data from 51 consecutive patients with CAVB complicating AMI treated in coronary care unit (CCU) from 1992 to 2005 were analyzed and compared with data from 102 AMI patients without CAVB, each of whom was admitted just before or after the admission of a corresponding CAVB patient. CAVB patients were divided into two groups according to whether or not receiving reperfusion therapy within 12 hours of symptoms onset. Data of 5 cases with a history of previous infarctions or systemic diseases, which may affect in-hospital prognosis, was excluded before analysis. Results Compared with patients without CAVB, patients with CAVB were older (P<0.01) and a greater proportion had inferior or right ventrical infarction (P<0.001). A statistically significant increase in the incidence of in-hospital mortality, ventricular fibrillation, cardiogenic shock and Killip class Ⅳwas observed among patients with CAVB, compared with that observed among patients without CAVB. Only 1 of 17 patients with reperfusion therapy was dead in hospital, compared with 12 of 29 patients without reperfusion (P<0.02). Conclusion Patients with CAVB complicating AMI have a significant worse prognosis than those without CAVB. Coronary reperfusion therapy may contribute to hospital survival of these patients.