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目的:根据心电图ST段改变对急性心肌梗死进行分型，探究不同类型急性心肌梗死患者的冠脉造影特点和冠脉内血栓类型。方法:连续纳入2016年9月至2018年8月因急性心肌梗死就诊于河南省人民医院，于发病24 h内行急诊冠脉介入治疗的232例患者。根据心电图ST段改变将患者分为ST段抬高组（n n=161）、ST段无偏移组（n n=28）和ST段压低组（n n=43）。于急诊冠脉介入治疗时行光学相干断层成像（optical coherence tomography, OCT）检查，在OCT的指导下对冠脉内血栓进行分型。采用单因素方差分析、卡方检验和Fisher精确概率法分析三组患者临床基线资料、冠脉造影特点和冠脉内血栓类型，n P<0.05为差异有统计学意义。n 结果:ST段抬高组和压低组的梗死相关动脉以左冠状动脉前降支和右冠状动脉多见，而无偏移组以左回旋支多见（n P<0.01）。ST段抬高组和压低组的梗死部位多位于近中段；而无偏移组多位于中远段（n P=0.008）。ST段抬高组、无偏移组的闭塞病变比例均高于ST段压低组（68.3% n vs. 30.2%，n P<0.05; 67.9%n vs. 30.2%, n P<0.05）；ST段抬高组、无偏移组的单支血管比例均高于ST段压低组（36.0%n vs 4.7%, n P<0.05；39.3%n vs. 4.7%, n P<0.05）。ST段无偏移组和压低组梗死相关动脉侧枝循环形成比例均高于ST段抬高组（35.7%n vs. 16.1%, n P<0.05; 58.1%n vs. 16.1%, n P<0.05）。ST段抬高组、无偏移组冠脉内红色血栓比例均高于无偏移组（76.4%n vs. 34.9%, n P<0.05; 64.3%n vs. 34.9%, n P<0.05）。n 结论:与ST段压低组相比，ST段无偏移组和ST段抬高组心肌梗死患者单支血管、闭塞病变所占比例较高，且冠脉内形成的多为红色血栓。故急性非ST段抬高型心肌梗死中ST段无偏移者有别于ST段压低者，建议将急性心肌梗死根据心电图进一步分为ST段抬高型、ST段无偏移型和ST段压低型。“,”Objective:To investigate the characteristics of coronary angiography and types of intracoronary thrombus in patients with acute myocardial infarction (AMI) who were classified according to changes of ST segment in electrocardiogram (ECG).Methods:A total of 232 consecutive AMI patients within 24 h of symptom onset undergoing primary percutaneous coronary intervention (PCI) in Henan Provincial People’s Hospital from September 2016 to August 2018 were included. According to the changes of ST segment, patients were divided into three groups: ST-elevated group (161 cases), ST-unoffset group (28 cases) and ST-depression group (43 cases). Optical coherence tomography (OCT) during primary PCI were performed and intracoronary thrombus types were differentiated according to OCT. One-way analysis of variance, Chi-square test and Fisher exact probability test were used to analyze the clinical baselines, angiographic characteristics and intracoronary thrombus types among the three groups. A n P<0.05 was considered statistically significant.n Results:Left anterior descending coronary artery and right coronary artery were the most common infarct related arteries in the ST-elevated group and ST-depression group, while left circumflex artery was more common in the ST-unoffset group (n P<0.001). The infarct sites in the ST-elevated group and ST-depression group were mostly located in the proximal and middLe segments, while those in the ST-unoffset group were mostly located in the middLe and distal segments (n P=0.008). The proportion of occlusive lesion in the ST-elevated group and ST-unoffset group was higher than that in the ST-depression group (68.3% n vs. 30.2%, n P<0.05; 67.9%n vs. 30.2%, n P<0.05). The proportion of single vessel in the ST-elevated group and ST-unoffset group was higher than that in the ST-depression group (36.0%n vs. 4.7%, n P<0.05; 39.3%n vs. 4.7%, n P<0.05). The proportion of collateral circulation of infarct related artery in the ST-unoffset group and ST-depression group was higher than that in the ST-elevated group (35.7%n vs. 16.1%, n P<0.05; 58.1%n vs. 16.1%,n P<0.05). The incidence of red thrombus in the ST-elevated group and ST-unoffset group was significantly higher than that in ST-depression group (76.4%n vs. 34.9%, n P<0.05; 64.3%n vs. 34.9%, n P<0.05).n Conclusions:Compared with the ST-depression group, the proportions of single-vessel, occlusive lesion and red thrombus are higher in the ST-unoffset group and ST-elevated group. Therefore, in acute non ST-segment elevated myocardial infarction, those without ST-segment deviation are different from those with ST-segment depression. It is recommended to further divide acute myocardial infarction into ST segment elevation type, ST segment unoffset type and ST segment depression type according to ECG.