冠状动脉造影正常的急性ST段抬高型心肌梗死临床分析Clinical analysis on acute ST-segment elevation myocardial infarction in patients with normal coronary angiography
赵荣诚,于靖,颜利求,王钢,韩立宪
摘要(Abstract):
目的研究在急性ST段抬高型心肌梗死(STEMI)患者中冠状动脉(冠脉)造影正常的发生率、临床特点和随访结果。方法选择2006年3月至2010年10月间收住沧州市中心医院的648例STEMI患者,分析其临床和冠脉造影结果,相关的冠心病危险因素和随访结果。结果 648例STEMI患者中有56例冠脉造影正常,占8.6%。该组患者中年龄较轻、大量吸烟者居多,多无心绞痛、糖尿病、高血压及高脂血症等病史,且多有情绪激动、过度劳累等明确诱因。完成随访的51例患者中,随访期间无患者发生急性心肌梗死或心原性死亡。结论 STEMI可以发生于冠脉造影正常的患者中,冠脉内皮受损继而引起冠脉痉挛或急性血栓形成并血栓自溶是其主要的发病机制;随访发现部分患者既使口服他汀类及钙拮抗剂等药物来稳定内皮、预防痉挛,仍有心绞痛症状发作,应引起重视。
关键词(KeyWords): 心肌梗死;冠状血管造影术;内皮,血管;冠状动脉血栓形成
基金项目(Foundation):
作者(Author): 赵荣诚,于靖,颜利求,王钢,韩立宪
参考文献(References):
- [1]江一清,刘朝中,朱国英,等.现代冠心病学.北京:人民军医出版社,2001:210-211.
- [2]Larsen AI,Galbraith P,Ghali WA,et al.Characteristics and outcomes of patients with acute myocardial infarction and angiographically normal coronary arteries.Am J Cardiol,2005,95:261-263.
- [3]Schwartz RS,Burke A,Farb A,et al.Microemboli and microvascular obstruction in acute coronary thrombosis and sudden coronary death:relation to epicardial plaque histopathology.Am Coll Cardiol,200954:2167-2173.
- [4]盛琴慧,王日胜,高炜,等.急性心肌梗死患者冠状动脉造影正常的临床分析.中国介入心脏病学杂志,2001,9:128-129.
- [5]张大东,张瑞岩,沈卫峰,等.冠状动脉造影正常的年轻人心肌梗死.中国介入心脏病学杂志,2001,9:81-82.
- [6]李秀清,洪涛,陈明,等.冠状动脉造影正常的急性心肌梗死患者临床预后的研究.中国介入心脏病学杂志,2004,12:234-236.
- [7]Barbash GI,White HD,Modan M,et al.Acute myocardial infarction in the young--the role of smoking.The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial.Eur Heart J,1995,16:313-316.
- [8]Davies MJ.Stability and instability:two faces of coronary atherosclerosis.Circulation,1996,94:2013-2020.
- [9]Yamashita T,Colombo A,Tobis JM,et al.Limitations of coronary Angiography Compared With Intravascular Ultrasound:Implications for Coronary Interventions.Prog Cardiovasc Dis,1999,42:91-138.
- [10]Widimsky P,Stellova S,Groch L,et al.Prevalence of normal coronary angiography in the acute phase of suspeted ST-elevation myocardial infarction:experience from the PRAGUE studies.Can J Cardiol,2006,22:1147-1152.