急性前壁心肌梗死墓碑型心电图改变患者

    冠状动脉造影特点及急诊介入治疗

    陈爱明1

    方唯一2

    迟贤国1

    蒋立民1

    赵毅1

    董振宇1

    张国春1

    周德越1

    [摘要] 目的:探讨前壁急性心肌梗死(AMI)墓碑型心电图改变患者临床、 冠状动脉病变特点及急诊冠状动

    脉介入治疗( PCI)的效果。方法:接受急诊 PCI的前壁 AMI患者 102 例 ,根据心电图特点 ,分为墓碑组(31 例)和

    非墓碑组(71 例) ,对比分析其临床、 冠状动脉病变特点、 即刻手术成功率和住院期间主要心脏事件的发生情况。

    结果:墓碑组梗死前心绞痛比例明显低于非墓碑型组( P < 0101) 。墓碑组犯罪病变多位于左前降支(LAD)近端

    (6415 %∶3616 % , P < 0101) ,并发右冠状动脉和左回旋支病变的比例高(5116 % ∶2111 % , P < 0101 ;3817 % ∶

    1710 % , P < 0101) ,术前 TIMI血流分级 0～1 级比例明显高于非墓碑组(8319 %∶5911 % , P < 0105) ,墓碑组发

    病2球囊开通时间明显短于非墓碑组[ (513 ±515) h ∶(714 ±618) h , P < 0105 ]。2 组术后 TIMI血流分级、 手术操

    作时间和手术成功率、 术后2 h心电图 ST段的回落程度、 肌酸激酶同工酶峰值、 左室射血分数及主要不良心脏事

    件的发生情况均差异无统计学意义( P > 0105) 。结论:墓碑型前壁 AMI患者犯罪病变多位于 LAD 近端且多为

    完全闭塞 ,常并发其他冠状动脉病变及缺乏良好的侧支循环保护 ,急诊 PCI是安全、 有效的 ,并能明显改善其预

    后。

    [关键词] 心肌梗死;冠状动脉造影;血管成形术 ,经腔 ,经皮冠状动脉;心电描记术

    [中图分类号] R542. 2 [文献标志码] A [文章编号] 100121439 (2008) 0320186203

    The characteristics of coronary angiography and primary percutaneous

    coronary intervention in patients with anterior w all acute myocardial

    infarction with“tombstoning”electrocardiographic pattern

    C H EN A imi ng

    1

    FA N G Wei y i

    2

    C H I X i ang uo

    1

    J IA N G L imi n

    1

    Z HA O Yi

    1

    DON G Zheny u

    1

    Z HA N G Guochun

    1

    Z HOU Dey ue

    1

    (

    1

    Department of Cardiology , t he First J inzhou Hospital of Dalian City , Dalian , 116100 , China ;

    2

    Department of Cardiology ,Shanghai Chest Ho spital)

    Abstract Objective :To explore the characteristics of coronary angiography and the safety and efficacy of pri2

    mary percutaneous coronary intervention in patient s with anterior wall acute myocardial infarction with " tombston2

    ing" elect rocardiographic ( ECG) pat tern. Method :The data of 102 patient s who were underwent primary percuta2

    neous coronary intervention during April 2004 to April 2006 were analyzed ret rospectively. They were divided into

    tombstoning ECGs group ( n = 31) and non2tombstoning ECGs group ( n = 71) according to ECGpat tern. The clin2

    ical characteristics , coronary angiography findings and in2hospital result s were analyzed in two group s. Result :The

    baseline characteristics two groups were similar except that preinfact angina were lower in tombstoning ECGs

    group . Compared with non2tombstoning ECGs group , The characteristics of coronary angiography was the signifi2

    cant differences in the tombstoning group , were as follows : ①LAD occlusions were mostly proximal (6415 %∶

    3616 % , P < 0101) ; ② patient s with tombstoning ECGs had a significantly greater incidence of RCA and LCX coro2

    nary lesion (5116 %∶2111 % , P < 0101 ;3817 %∶1710 % , P < 0101) ) ; ③patient s with tombstoning ECGs had a

    significantly greater incidence of TIMI flow 0 - 1 grade before PCI (8319 %∶5911 % , P < 0105) ; ④patient s with

    tombstoning ECGs were lack of good collateral circulation. There was no significant difference between the two

    groups on instant , clinical outcomes , time of procedure and procedural success rate , Time of symptom2balloon

    (hour) was shorter in tombstoning ECGs (513 ±515 ∶714 ±618 , P < 0105) . ST2segment resolution , peak of CK 2

    MB , LVEF , and major adverse cardiac event s were similar in two group s. Conclusion :The patient s with tomb2

    stoning pat tern on the admission ECG, who underwent angiography , were associated with occlusion of the proxi2 ......