Clinical features of acute non-ST elevation myocardial infarction associated with acute total occlusion of the circumflex artery
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摘要: 目的 探讨回旋支急性闭塞病变引起的急性非ST段抬高型心肌梗死(NSTEMI)的临床特点。方法 回顾性对比分析71例回旋支急性完全闭塞和223例不完全闭塞病变引起的急性NSTEMI患者的临床特点，包括心电图、冠状动脉(冠脉)造影特点、介入治疗时机选择、住院期间主要不良心血管事件(MACE)发生率等指标。结果 心电图表现复杂多样，部分病例avR和V1导联ST段抬高而V2~5导联及Ⅱ、Ⅲ和avF导联ST段压低，呈现类似左主干病变心电图特点而被高估风险，部分病例心电图正常而被低估风险。超过24 h延迟介入比例高达43%，急性完全闭塞组超过24 h延迟介入占比23.9%，住院期间MACE发生率为9.6%，急性不完全闭塞组超过24 h延迟介入占比为48.4%，住院期间MACE发生率为2.7%，两组均有显著性差异。急性完全闭塞组早发冠心病、单支病变、心电图正常或类似左主干病变者心电图显著多于未完全闭塞组。结论 左回旋支病变引起的急性NSTEMI的心电图表现复杂多变，超过24 h延迟介入比例很高。急性完全闭塞性病变约占25%，常合并早发冠心病、单支病变、心电图正常或类似左主干病变心电图表现，虽然有较低的24 h外延迟介入比例，仍有较高的住院期间MACE。
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关键词:
- 非ST段抬高型心肌梗死 /
- 回旋支 /
- 心电图 /
- 完全闭塞
Abstract: Objective To investigate the clinical features of acute non-ST elevation myocardial infarction caused by acute occlusive lesions of circumflex artery.Methods The clinical characteristics of 71 patients with acute total occlusion of circumflex artery and 223 patients with acute incomplete occlusion of circumflex artery were retrospective compared and analyzed, including electrocardiogram, coronary angiography features, timing of interventional therapy, and incidence of major adverse cardiac events during hospitalization.Results The ECG features were complex and variable. Risk were overestimated in some cases whose ST segment elevated in lead avR and V1 and ST segment depressed in lead V2-5, Ⅱ, Ⅲ and avF with similar ECG characteristics of left main coronary artery lesion, while risks were underestimated in some cases whose ECG is normal. Overall, the proportion of delayed interventional therapy beyond 24 hours was 43%. The proportion of delayed interventional therapy beyond 24 hours was 23.9% and the incidence of major adverse cardiac events during hospitalization was 9.6% in the acute total occlusion group. The proportion of delayed intervention beyond 24 hours was 48.4% and the incidence of major adverse cardiac events during hospitalization was 2.7% in the acute incomplete occlusion group. There were significant differences between the two groups. The incidence of early-onset coronary heart disease, single coronary artery lesion, normal electrocardiogram or similar left main coronary artery lesion in the acute total occlusion group were significantly higher than that in the incomplete occlusion group.Conclusion The ECG features of acute non-ST elevation myocardial infarction caused by circumflex artery acute lesion were complex and variable, with a high proportion of delayed intervention beyond 24 hours. Acute total occlusive lesions group accounted for about 25%, often combined with early-onset coronary heart disease, single coronary artery lesions, normal electrocardiogram or similar ECG features of left main coronary artery lesions. Although there is a low proportion of delayed interventional therapy beyond 24 hours, there is still a high incidence of major adverse cardiac events during hospitalization in acute total occlusive lesions group. -
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表 1 两组的一般情况比较
Table 1. General data
例(%) 项目 完全闭塞组(71例) 不完全闭塞组(223例) P 男性 40(56.3) 129(57.8) >0.05 早发冠心病* 30(42.2) 42(18.8) <0.05 高血压 23(32.3) 85(38.1) >0.05 糖尿病 21(29.5) 67(30.0) >0.05 吸烟 10(14.1) 37(16.6) >0.05 高脂血症 23(32.4) 69(30.9) >0.05 单支病变 50(70.4) 141(63.2) <0.05 完全性房室传导阻滞 2(2.8) 0 >0.05 束支传导阻滞 2(2.8) 3(1.3) >0.05 心房颤动 2(2.8) 5(2.2) >0.05 ECG无ST-T改变表现 18(25.3) 26(11.6) <0.05 ECG类左主干病变表现 5(7.0) 4(1.8) <0.05 Killip Ⅱ级以上 2(2.8) 5(2.2) >0.05 既往血运重建史 2(2.8) 8(3.6) >0.05 住院期间MACE 7(9.6) 6(2.7) <0.05 24 h内介入 54(76.1) 115(51.6) <0.05 *早发冠心病发病年龄为男性<55岁、女性<65岁。 
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