梗塞前心绞痛对急性心肌梗塞患者的有益作用

43例首次穿壁性急性心肌梗塞(AMI)患者于静脉内溶栓后90min行冠状动脉造影.其中24例AMI前6h内有心绞痛(甲组),另19例梗塞前无心绞痛(乙组).尽管两组多支冠状动脉病变及侧支循环发生率相似.但甲组异常Q波导联数、QRS积分、CPK峰值及CPK峰值距发病时间显著低于乙组.而梗塞相关冠状动脉再通率显著高于乙组.22例IRA开通患者中,有心绞痛者其基础左心室功能较无心绞痛者好.出院前超声心动图检查显示,甲组左心室局部和整体收缩功能、舒张充盈明显改善,而乙组收缩功能降低、舒张充盈无明显变化.住院期心脏事件发生率甲组显著低于乙组.本文提示,梗塞前心绞痛可能由于早期心肌再灌注和缺血预适应对梗塞大小、左心室功能及预后具有益作用.

Benefical effects of preinfarction angina in patients with acute myocardial infarction

Among 43 patients with a first transmural acute myocardial infarcion(AMI) who have undergone coronary angiography 90 minutes after intravenous thrombolytic therapy, 24 patients had (group Ⅰ) and 19 did not have angina pectoris (group Ⅱ ) 6 hours before AMI. Despite similar occurrence rate, of multivessel coronary disease and collateral circulation, the number of e.lectrocardiographic leads with pathological Q wave, QRS score.peak CPK and time to peak CPK were significantly lower and patency rate of the infarct-related artery was higher in group Ⅰ than in group Ⅱ. In 22 patients with reperfused IRA,the left ventricular function was better in patients with than in those without angina pectoris. Doppler echocardiographic examination at discharge showed that left ventricular global and regional function and diastolic filling were improved in group Ⅰ but were unchanged in group Ⅱ . Cardiac event rate during hospitalization was lower in group Ⅰ than in group Ⅱ. The study suggests that patients with angina pectoris 6h before AMI may have reduced infarct size, improved left ventricular function and clinical outcome due to early recanalization of the infarct-related artery and ischemic myocardial preconditioning.