作者：肖文颖，汪宇，张佳雨，史骏，刘新兵，冯六六

单位：

200438上海市杨浦区市东医院心内科 通信作者：汪宇，E-mail：wangyushidonghos@163.com

Units：

Internal Medicine-Cardiovascular Department, Shidong Hospital, Yangpu District, Shanghai, Shanghai 200438, China Corresponding author: WANG Yu, E-mail: wangyushidonghos@163.com

关键词：

非ST段抬高型心肌梗死; 梗死相关动脉; 冠状动脉闭塞; 临床特征; 前驱症状;

Keywords：

Non-ST elevated myocardial infarction; Infarct-related artery; Coronary occlusion; Clinical feature;Prodromal symptoms

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.066

Funds：

上海市科技计划项目（21YF1443300）；上海市医学重点专科建设项目（YP19ZA09）

摘要：

背景梗死相关动脉(IRA)完全闭塞在非ST段抬高型心肌梗死(NSTEMI)患者中越来越常见,其临床表现缺乏典型性。目的 分析不同IRA完全闭塞的NSTEMI患者的临床特征。方法 选取2018年3月至2021年3月入住上海市杨浦区市东医院心脏重症监护室(CCU)并经24 h内冠状动脉造影(CAG)证实IRA完全闭塞的NSTEMI患者79例为研究对象。收集患者一般资料、前驱症状、心电图检查结果、CAG检查结果。根据患者IRA,将其分为右冠状动脉(RCA)组(33例)、左回旋支(LCX)组(26例)和左前降支(LAD)组(20例)。结果 三组前驱症状比较,差异无统计学意义(P>0.05)。三组新出现的病理性Q波、ST段偏移、T波倒置、完全性左束支传导阻滞(CLBBB)发生率比较,差异无统计学意义(P>0.05)。三组三支病变、RCA优势型发生率比较,差异无统计学意义(P>0.05);LCX组侧支循环良好率低于RCA组(P<0.05);LAD组病变位置为近段者所占比例高于LCX组,病变位置为远段者所占比例低于LCX组(P<0.05)。前驱症状为气促的患者多见于LAD近段完全闭塞,前驱症状为头晕的患者多见于RCA近段完全闭塞,前驱症状为晕厥的患者均见于LCX完全闭塞,前驱症状为消化道症状的患者多见于RCA远段完全闭塞。结论 不同IRA完全闭塞NSTEMI患者前驱症状均以典型胸痛为主,但前驱症状为气促的患者多见于LAD近段完全闭塞,前驱症状为头晕的患者多见RCA近段完全闭塞,前驱症状为晕厥的患者均见于LCX完全闭塞,前驱症状为消化道症状的患者多见于RCA远段完全闭塞;不同IRA完全闭塞NSTEMI患者心电图检查结果无特异性;LCX完全闭塞NSTEMI患者CAG检查结果较差,其病情可能较为凶险。

Abstract：

【Abstract】　Background Complete occlusion of infarct-related artery (IRA) is becoming more and more common inpatients with non-ST elevated myocardial infarction (NSTEMI) , and its clinical manifestations are lack of typicality. ObjectiveTo analyze the clinical characteristics of NSTEMI patients with complete occlusion of different IRA. Methods A total of 79NSTEMI patients who were admitted to the Coronary Care Unit (CCU) of Shidong Hospital, Yangpu District, Shanghai from March2018 to March 2021 and confirmed complete occlusion of IRA by coronary angiography (CAG) within 24 hours were selected asthe research objects. The general data, prodromal symptoms, ECG results and CAG results of patients were collected. According toIRA, patients were divided into right coronary artery (RCA) group (33 cases) , left circumflex artery (LCX) group (26 cases) and leftanterior descending artery (LAD) group (20 cases) . Results There was no significant difference in prodromal symptoms amongthe three groups (P >0.05) . There was no significant difference in the incidence of new pathological Q wave, ST segment offset,T wave inversion and complete left bundle branch block (CLBBB) among the three groups (P >0.05) . There was no significantdifference in the incidence of three vessel lesions and dominant RCA among the three groups (P >0.05) . The good rate of collateralcirculation in LCX group was lower than that in RCA group (P <0.05) . The proportion of lesions located in the proximal segment inLAD group was higher than that in LCX group, and the proportion of lesions located in the distal segment was lower than that in LCXgroup (P <0.05) . Patients who had shortness of breath as prodromal symptoms were more common with complete occlusion of proximalLAD, patients who had dizziness as prodromal symptoms were more likely to have complete occlusion of the proximal RCA, patientswho had syncope as prodromal symptoms were seen with complete occlusion of the LCX, patients who had gastrointestinal symptoms asprodromal symptoms were mostly seen with complete occlusion of the distal RCA. Conclusion The prodromal symptoms of NSTEMIpatients with different IRA complete occlusion are mainly typical chest pain, but the patients who have shortness of breath as prodromalsymptoms are more common with complete occlusion of proximal LAD, patients who have dizziness as prodromal symptoms are morelikely to have complete occlusion of the proximal RCA, patients who have syncope as prodromal symptoms are seen with completeocclusion of the LCX, patients who have gastrointestinal symptoms as prodromal symptoms are mostly seen with complete occlusion ofthe distal RCA; there is no specificity in ECG results of NSTEMI patients with complete occlusion of different IRA; the CAG results ofpatients with LCX total occlusion NSTEMI are poor, and their condition may be dangerous.

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