前壁合并下壁心肌梗死的临床特点及罪犯血管

目的探讨前壁合并下壁心肌梗死的临床特点及其与冠状动脉造影结果的关系。方法对22例前壁合并下壁心肌梗死患者进行回顾性研究分析。结果本组患者22例,男21例,女1例。合并高血压病、高脂血症及糖尿病分别为72.7%、31.8%和18.2%。有吸烟史占22.7%。典型胸痛、不典型胸痛及无胸痛分别为54.5%、22.7%和22.7%。胸片、心脏超声、心电图及肾功能异常分别为72.7%、100%、100%和18.2%。冠状动脉造影显示:冠脉为右优势分布14例,占63.6%,左优势分布3例,占13.6%;均衡型分布5例,占22.7%。病变累及冠脉66支共76处,单支病变22.7%、二支病变27.3%、多支病变50.0%,受累的前降支(LAD)、右冠状动脉(RCA)、左回旋支(LCX)及左主干(LM)分别为100%、54.5%、72.7%和9.1%。A型病变累及冠脉17支22处(25.8%)、B型病变累及冠脉26支30处(39.4%)、C型病变累及冠脉23支24处(34.8%),重度以上狭窄占80.3%。16例(72.7%)有不同程度的侧支循环。3例AAMI+AIMI中,2例罪犯血管为单支病变,均为LAD,1例为多支病变,累及LAD、LCX及RCA。结论前壁合并下壁心肌梗死患者,多合并危险因素,临床表现复杂,临床检查多有异常,冠脉分布以右优势型居多,冠脉病变以二支及多支病变为主,B型及C型病变占大多数、冠脉狭窄程度较严重,多数患者有不同程度的侧支循环。AAMI+AIMI中,罪犯血管多为LAD,且预后良好。

The clinical features and culprit arteries in patients with anterior myocardial infarction combined with infieror myocardial infarction

Objective To explore the relationship between clinical characteristics and results of coronary angiography in patients with anterior myocardial infarction combined with infieror myocardial infarction.Methods Retrospective analysis was performed in 22 patients with anterior myocardial infarction combined with infieror myocardial infarction.Results 21 of 22 patients were men.The history of hypertention,hyperlipemia,diabetes mellitus and cigarette-smoking,accounted for 72.7%,31.8%,18.2% and 22.7% of 22 total cases respectively.Those with typical chest pain,atypical chest pain and no chest pain accounted for 54.5%,22.7% and 22.7% respectively.Abnormal chest X-ray,echocardiography,electrocardiogram and kidney function were found in 72.7%,100%,100% and 18.2% of the total cases respectively.Coronary angiography(CAG) showed that the right coronary artery(RCA) dominated distribution were 14 cases (63.6%),the left coronary artery(LCA)dominated were 3 cases (13.6%),and the balanced were 5 cases (22.7%).CAG showed that there were 66 stenotic coronary arteries with 76 target lesions in the patients,including 22 (25.8%)type A lesions in 17 branches,30(39.4%) type B lesions in 26 branches and 24(34.8%)type C lesions in 23 branches.Narrowness with the single branch lesion,two-branch lesion and multiple branch lesions accounted for 22.7%,27.3% and 50.0% respectively,the frequency of involved vessels detected on angiograms ranked,in descending order,as LAD,RCA,LCX and LM,and seriously narrowed lesions accounted for 80.3%.Different degree of collateral circulation were found in 16 cases (72.7%).In 3 patients with AAMI+AIMI,CAG confirmed that the single-branch lesion of LAD accounted for two of them,and the other culprit artery was a multiple-branch lesion including LAD,RCA and LCX.Conclusion Most of the patients with Anterior Myocardial Infarction Combined with Infieror Myocardial Infarction had more risk factors,the clinical feature was complicated,and the cinical examination were of ten abnormal.The distribution of coronary artery was often RCA dominated.Two-branch and multiple branch lesions were involved in most patients,the degree of narrowness was of ten severe.The type B and type C lesion,and different degree of callateral circulation were found in most cases.In patients with AAMI+AIMI,the culprit artery was often LAD,and the prognosis of them was better.