摘要
目的 探讨首次心肌梗死 (MI)后冠状动脉病变的特点。方法 对 1998年 5月至 2 0 0 0年 12月间在中国协和医科大学阜外心血管病医院完成择期冠状动脉造影 (≤ 6个月 )的首次MI连续病例 878例的造影结果进行分析。其中前、侧壁MI 4 81例 ,下、后壁MI 36 8例 ,后、侧壁MI 19例 ,不详者 10例。曾予溶栓治疗者 394例 ,明确成功 176例 ( 4 4 7% ) ;MI前、后有心绞痛发作者分别占 5 9 8%和 4 8 7%。结果 ( 1) 878例中 ,单支、双支和 3支或 4支 (合并中间动脉 )病变者分别占 32 8%、2 6 4 %和 34 9% ,无明显狭窄或正常者仅占 5 9% ,合并左主干病变者占 3 2 %。MI前有心绞痛史者≥ 3支病变者的比例明显高于无心绞痛史者 ( 39 2 %比 2 8 3% ,P <0 0 1) ,而溶栓者明显低于未溶栓者 ( 30 5 %比 38 4 % ,P <0 0 5 )。 ( 2 )推测梗死相关动脉 (IRA)的狭窄程度为 10 0 %闭塞、95 %～ 99%次全闭塞、70 %～ 94 %严重狭窄、5 0 %～ 6 9%临界狭窄者分别占 2 9 6 %、2 2 6 %、37 9%和 4 9% ,而 <5 0 %者仅占 5 1% ;溶栓治疗组完全闭塞者比例比未溶栓或不详组低 ,差异有显著意义 ( 2 4 6 %比33 7% ,P <0 0 1)。 ( 3) 878例患者中至少有 1处主要冠状动脉病变狭窄≥ 70 %、≥ 90 %、≥ 95 %和10 0
Objective To investigate the characteristics of coronary lesions in patients after first myocardial infarction (MI) Methods From May 1998 to December 2000, coronary angiography was performed on 878 consecutive cases who had had first MI within 6 months and without history of previous coronary revascularization, 481 with anterior lateral MI, 368 with inferior posterior MI, 19 with posterio lateral MI, and 10 with location undetermined MI, and 394 receiving thrombolytic therapy 176 (44 7%) of which were treated successfully, and 525 (59 8%) with history of pre infarction angina pectoris and 428 (48 7%)with history of post infarction angina pectoris Results (1)Normal coronary vessels or lesions less than 50% stenosis were seen only in 5 9% (52) of the patients One , two and three vessel diseases were present in 32 8% (288), 26 4%(232) and 34 9% (306) patients respectively 3 2% (28) had concomitant left main stem (LMS) disease Three vessel coronary disease was significantly more common in the patients with a history of pre infarction angina in comparison with those without such history (39 2% vs 28 3%, P <0 01), and was significantly more common in the patients who did not undergo thrombolytic therapy in comparison with those who had received thrombolytic therapy (38 4% vs 30 5%, P <0 05). (2)Only in 5 1% (41) cases the infarct related artery (IRA) was normal or with lesions less than 50% stenosis.Total occlusion (100% stenosis), subtotal occlusion (95% to 99% stenosis), severe stenosis (70% to 94% stenosis) and borderline stenosis (50% to 69% stenosis) of IRA were seen in 29 6% (240), 22 6% (183), 37 9% (307) and 4 9% (40) of the cases respectively Total occlusion of IRA occurred significantly less often in the thrombolytic group than in the non thrombolytic group (24 6% vs 33 7%, P <0 01) IRA could not be determined in 67 cases (3) 90 5% (795), 79 4% (697), 57 2% (502) and 35 6% (313) of the patients had ≥70% stenosis, ≥90% stenosis, ≥95% stenosis and total occlusion coronary lesions in at least one major coronary artery respectively, and coronary revascularization including PCI and CABG was needed on 84% (736/878) of the patients Conclusion Patients with a first MI usually have multi vessel disease and severe coronary stenosis, with IRA having severe stenotic lesions Revascularization treatment is needed in the majority of the patients It is true too for the MI patients without history of pre or post infarction angina pectoris and those with successful thrombolytic therapy Coronary angiography should routinely be performed on the patients who need further coronary revascularization
出处
《中华医学杂志》
CAS
CSCD
北大核心
2004年第11期910-914,共5页
National Medical Journal of China
