| | | | | 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;方唯一;迟贤国;蒋立民;赵毅;董振宇;张国春;周德越 | | | 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<0.01)。墓碑组犯罪病变多位于左前降支(LAD)近端(64.5%∶36.6%,P<0.01),并发右冠状动脉和左回旋支病变的比例高(51.6%∶21.1%,P<0.01;38.7%∶17.0%,P<0.01),术前TIMI血流分级0~1级比例明显高于非墓碑组(83.9%∶59.1%,P<0.05),墓碑组发病-球囊开通时间明显短于非墓碑组[(5.3±5.5)h∶(7.4±6.8)h,P<0.05]。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>0.05)。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。
【作者单位】：大连市金州区第一人民医院心内科;上海胸科医院心内科;大连市金州区第一人民医院心内科;大连市金州区第一人民医院心内科;大连市金州区第一人民医院心内科;大连市金州区第一人民医院心内科;大连市金州区第一人民医院心内科;大连市金州区第一人民医院心内科 辽宁大连;116100;辽宁大连;116100;辽宁大连;116100;辽宁大连;116100;辽宁大连;116100;辽宁大连;116100;辽宁大连;116100
【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
【分类号】：R542.22
【DOI】：CNKI:SUN:LCXB.0.2008-03-010
【正文快照】：
心电图作为一种简便、无创的检查手段已被广泛应用于急性心肌梗死(AMI)的诊断与评估,一般认为ST段抬高具有最佳的诊断价值〔1〕。长期以来大多数研究者对AMI评估主要放在ST段抬高的导联数和ST段抬高的振幅上,而对ST段抬高的形态重视不够〔1,2〕。本文通过回顾性分析我院开展急 | | |
| | |  推荐 下载CAJ全文  下载PDF全文 | | | CAJViewer7.0阅读器支持所有CNKI文件格式，AdobeReader仅支持PDF格式 | | | | The characteristics of coronary angiography and primary percutaneous coronary intervention in patients with anterior wall acute myocardial infarction with "tombstoning" electrocardiographic pattern | | | CHEN Aiming1 FANG Weiyi2 CHI Xianguo1 JIANG Limin1ZHAO Yi1 DONG Zhenyu1 ZHANG Guochun1 ZHOU Deyue1(1Department of Cardiology;the First Jinzhou Hospital of Dalian City;Dalian;116100;China;2Department of Cardiology;Shanghai Chest Hospital) | | | Objective:To explore the characteristics of coronary angiography and the safety and efficacy of primary percutaneous coronary intervention in patients with anterior wall acute myocardial infarction with "tombstoning" electrocardiographic(ECG) pattern.Method:The data of 102 patients who were underwent primary percutaneous coronary intervention during April 2004 to April 2006 were analyzed retrospectively.They were divided into tombstoning ECGs group(n=31) and non-tombstoning ECGs group(n=71) according to ECG pattern.The clinical characteristics,coronary angiography findings and in-hospital results were analyzed in two groups.Result:The baseline characteristics two groups were similar except that preinfact angina were lower in tombstoning ECGs group.Compared with nontombstoning ECGs group,The characteristics of coronary angiography was the significant differences in the tombstoning group,were as follows: ①LAD occlusions were mostly proximal(64.5%∶36.6%,P<0.01);②patients with tombstoning ECGs had a significantly greater incidence of RCA and LCX coronary lesion(51.6%∶21.1%,P<0.01;38.7%∶17.0%,P<0.01));③patients with tombstoning ECGs had a significantly greater incidence of TIMI flow 0-1 grade before PCI (83.9%∶59.1%,P<0.05);④patients 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 symptom-balloon(hour) was shorter in tombstoning ECGs(5.3±5.5∶7.4±6.8,P<0.05).ST-segment resolution,peak of CK-MB,LVEF,and major adverse cardiac events were similar in two groups.Conclusion:The patients with tombstoning pattern on the admission ECG,who underwent angiography,were associated with occlusion of the proximal LAD artery and usually with involvement of more than one artery,and lack of good collateral circulation.Primary PCI was safe and effective,and could improve the prognosis of the patients with tombstoning pattern.
【Keyword】：Myocardial infarction;Coronary angiography;Angioplasty,transluminal,percutaneous coronary;Electrocardiography |
| | | | | | 1 | Christian T F, Gibbons R J, Clements I P, et al; Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures [M];Journal of the American College of Cardiology; 1995年 | | 2 | Willems JL, Willem RJ, Willems GM, et al; Significance of initial ST segment elevation and depression for the management of thrombolytic therapy in acute myocardial in farction [M];Circulation; 1990年 | | 3 | Guo XH, Yap YG,Chen LJ, et al; Correlation of Coronary Angiography with"Tbmbstoning"Electrocardiographic Pattern in Patients after Acute Myocardial Infarction [M];Clinical Cardiology; 2000年 | | 4 | Wimalaratna HSK; Tombstoning of ST segment in acute myocardial infarction [M];Lancet, The; 1993年 | | 5 | Bahattin Balci, Osman Yesildag; Correlation between clinical findings and the " Tombstoning" electrocardiographic pattern in patients with anterior wall acute myocardial infarction [M];American Journal of Cardiology; 2003年 | | 6 | Huang J, Redwood S, Poloniecki J, et al; Predicting death from " tombstoning" of the ST-segment in acute myocardial infarction [M];Circulation; 1994年 | | 7 | ALDRICH H R,WAGNER N B,BOSWICK J,etal; Use initial ST segment deviation for prediction offinal electrocardiographic size of acute myocardial in-farction.acute myocardial infarction[J] [M];Am J Cardi-ol; 1998年 | | 8 | KEELEY E C,BOURA J A,GRINES C L,et al; Primary angioplasty versus intravenous thrombolytictherapy for acute myocardial infarction:a quantitativereview of 23 randomized trial[J] [M];Lancet; 2003年 |
|
| | | | | | 1 | 陈爱明,董振宇,张国春,迟贤国,蒋立民,周德越,赵毅; 墓碑型心电图改变心肌梗死患者冠状动脉病变特点及临床意义 [J];临床心电学杂志; 2007年03期 | | 2 | 陈爱明,方唯一,迟贤国,蒋立民,张国春,董振宇,周德越; 直接经皮冠状动脉介入治疗墓碑型心电图改变急性前壁心肌梗死的疗效和随访研究 [J];中国介入心脏病学杂志; 2007年06期 |
|
| | | | | | 1 | Sagie A, Sclarovsky S, Strasberg B, et al; Acute anterior wall myocardial infarction presenting with positive T waves and without ST segment shift.Electrocardiographic features and angiographic correlation [M];Chest; 1989年 | | 2 | Gheeraert P J, Henriques J P S, De Buyzere M L, et al; Preinfarction angina protects against out-of-hospital ventricular fibrillation in patients with acute occlusion of the left coronary artery [M];J Am Coll Cardiol; 2001年 | | 3 | Van de Werf F, Ardissino D, Betriu A, et al; Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.Management of acute myocardial infarction in patients presenting with ST-segment elevation [M];Eur Heart J; 2003年 | | 4 | Christian T F, Gibbons R J, Clements I P, et al; Estimates of myocardium at risk and collateral flow in acute myocardial infarction using electrocardiographic indexes with comparison to radionuclide and angiographic measures [M];J Am Coll Cardiol; 1995年 |
|
| | | | | | 1 | 张云红,曹晶茗; 冠状动脉造影正常的急性心肌梗死2例 [J];临床心血管病杂志; 2007年03期; 74-75 | | 2 | 杨锋,李易,卢竞前,李劲松,白洁,李绍龙; 猪心肌梗死模型制作和猪冠状动脉造影方法探讨 [J];中国实用医药; 2007年21期; 108 | | 3 | 刘福颂,王玉,周长勇; 非ST段抬高型心肌梗死冠状动脉造影48例分析 [J];齐鲁医学杂志; 2006年06期; 79 | | 4 | 罗彩东,张再伟,王羽,吴屹,赵亮,刘云兵; 冠状动脉造影正常的心肌梗死18例临床分析 [J];现代临床医学; 2006年01期; 29-30 | | 5 | 袁伟,张尚杰; 急性下壁心肌梗死病人ST段下降与冠状动脉造影结果的关系 [J];中西医结合心脑血管病杂志; 2005年10期; 78-79 | | 6 | 陈洪,艾伟民,李峥,李宇,赵风龙,乔汉勇; 体表心电图判断急性心肌梗死相关动脉的意义 [J];中西医结合心脑血管病杂志; 2006年09期; 78-79 | | 7 | 苏晞,游斌权; 冠状动脉造影正常的心肌梗死后室壁瘤11例分析 [J];岭南心血管病杂志; 2005年05期; 27-29 | | 8 | 袁伟,张尚杰; 急性下壁心肌梗死患者心电图胸前导联ST段下降与冠状动脉造影结果的对比分析 [J];中国社区医师; 2005年19期; 28-29 | | 9 | 马小川,李晓莉,王营忠,刘兆英,王晨霞,王东琦; 青年人急性心肌梗死临床及冠状动脉病变特点的探讨 [J];延安大学学报(医学科学版); 2004年03期; 13-15 | | 10 | 李秀兰,程兰慧; 心肌梗死病人恢复期的饮食指导 [J];实用医技杂志; 2005年20期; 87 |
|
| | | | | | 1 | 范珊; 26例冠状动脉造影所见与临床表现的联系 [A];中华医学会第一次全国介入医学学术会议论文汇编 [C]; 2001年 | | 2 | 高瑜明,刘永斌,刘宇,李华承; 26例女性冠状动脉造影分析 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 3 | 华巧霞,钱建业; 心肌损伤标志物检测心肌梗死的临床应用及探讨 [A];全国第三届心脑血管疾病学术会议论文集 [C]; 2003年 | | 4 | 魏盟,马士新,葛雷,蔡迺绳,Harry Hemingway,Kim Greaves; 中国上海和英国伦敦入院行冠状动脉造影患者临床及影像学特点比较 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 5 | 栾波,荆全民,韩雅玲; 风湿性瓣膜病冠状动脉造影的资料分析 [A];国际介入心脏病学研讨会（CIT）暨全国介入心脏病学年会2004专辑 [C]; 2004年 | | 6 | 朱海云; MR心脏扫描检测活性心肌及其和冠状动脉造影、SPECT、和PET显像对比的临床研究 [A];中华医学会第十三届全国放射学大会论文汇编（下册） [C]; 2006年 | | 7 | 于忠,王宁夫,张邢炜; 年轻心肌梗死患者急诊冠状动脉造影及临床特征分析 [A];2006年浙江省心血管病学学术年会论文汇编 [C]; 2006年 | | 8 | 张增堂; 冠状动脉造影与冠心病中西医结合诊疗康复研究 [A];第三次全国中西医结合养生学与康复医学学术研讨会论文集 [C]; 2002年 | | 9 | 魏盟,马士新,葛雷,蔡迺绳,Harry Hemingway,Kim Greaves; 中国上海和英国伦敦入院行冠状动脉造影患者临床及影像学特点比较 [A];中华医学会心血管病分会第八次全国心血管病学术会议汇编 [C]; 2004年 | | 10 | 李健,张敏州,陈伯钧; 431例选择性冠状动脉造影结果分析 [A];第六次全国中西医结合心血管会学术会议论文汇编 [C]; 2002年 |
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