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目的:从临床角度更深入理解急性ST段抬高性心肌梗死(STEMI)或急性非ST段抬高性心肌梗死(NSTEMI)的冠状动脉病变特点。方法:入选2003年12月至2006年9月间,症状发作24小时内行冠状动脉造影的急性心肌梗死(AMI)患者,选择造影结果提示梗塞相关血管为次全闭塞或未闭塞的患者为急性STEMI组(42例),与梗塞相关血管为完全闭塞的患者为急性NSTEMI组(16例)比较两组患者病变特点。结果:急性STEMI组的梗塞相关血管均为主支血管,而急性NSTEMI组梗塞相关血管非主支血管较多,急性STEMI组与急性NSTEMI组相比,有显著性差异[0例vs6例(37.5%),P<0.05]。急性STEMI组梗塞相关血管病变位于主支血管的近段或中段较急性NSTEMI组为多,有显著性差异[38例(90.5%)vs7例(43.8%),P<0.05]。梗塞相关血管造影可见侧支者,急性STEMI组较急性NSTEMI组少,有显著性差异[10例(23.8%)vs10例(62.5%),P<0.05]。结论:与急性NSTEMI患者相比,急性STEMI患者中,梗塞相关血管病变位于主支冠状动脉及其近中段者较多,而侧支循环较少。
OBJECTIVE: To further understand the characteristics of coronary artery lesions in acute ST-segment elevation myocardial infarction (STEMI) or acute non-ST-segment elevation myocardial infarction (NSTEMI) from a clinical perspective. Methods: Patients with acute myocardial infarction (AMI) undergoing coronary angiography within 24 hours after the onset of symptoms were enrolled in this study. Patients who underwent angiography showed that the infarct-related vessels were subtotal or unobstructed and were acute STEMI (N = 42). The patients with complete occlusion of blood vessels in the infarction group were compared with the acute NSTEMI group (n = 16). Results: The infarct-related blood vessels in the acute STEMI group were predominantly blood vessels, whereas the infarct-related non-predominant blood vessels in the acute STEMI group were significantly different compared with the acute STEMI group [0 vs 6 (37.5 %), P <0.05]. Acute STEMI group infarct-related vascular lesions located in the proximal or middle part of the main branch of the blood than the more acute NSTEMI group, there were significant differences [38 (90.5% vs7.83%, P <0.05]. Infarct-related angiography showed that there were fewer side branches in the acute STEMI group than in the acute NSTEMI group [10 (23.8%) vs 10 (62.5%), P <0.05]. CONCLUSIONS: Compared with patients with acute NSTEMI, in patients with acute STEMI, there are more infarction-related vascular lesions in the main coronary artery and its proximal middle part with less collateral circulation.