Yano K, Yoshino H, Taniuchi M, Kachi E, Shimizu H, Watanuki A, Ishikawa K
Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan.
Clin Cardiol. 2001 Mar;24(3):202-8. doi: 10.1002/clc.4960240306.
We observed marked myocardial bridging of the left anterior descending coronary artery (LAD) in the acute stages of inferior wall myocardial infarction (MI) in a group of patients who developed shock despite successful reperfusion of the infarct-related lesion (IRL).
The purpose of this study was to elucidate the clinical significance of myocardial bridging in patients with inferior wall MI and shock.
The study group consisted of 53 patients with single-vessel disease of the right coronary artery, who underwent coronary angiography for acute inferior wall MI. Clinical characteristics, coronary angiographic findings, and left ventricular function during the chronic phase were compared between the patients who developed shock (the shock group) and those who did not (the non-shock group). In addition, a multiple logistic analysis was performed to identify independent predictors of shock in patients with acute inferior wall MI.
Reperfusion of the IRL was obtained in all 53 patients. The incidence of myocardial bridging of the LAD, the incidence of right ventricular MI, the peak creatine phosphokinase (CPK-MB). the pulmonary capillary wedge pressure, and the prevalence of pulmonary congestion seen on chest roentgenogram were significantly higher in the shock group than in the non-shock group. Myocardial bridging (p = 0.0018), right ventricular MI (p = 0.0374), and peak CPK-MB (p = 0.0189) were identified as independent predictors of shock in acute inferior wall MI.
This study suggests that myocardial bridging plays a role in left ventricular function in the acute stage of inferior wall MI.
我们在一组尽管梗死相关病变（IRL）成功再灌注但仍发生休克的下壁心肌梗死（MI）急性期患者中，观察到左前降支冠状动脉（LAD）存在明显的心肌桥。
本研究的目的是阐明下壁MI合并休克患者中心肌桥的临床意义。
研究组由53例右冠状动脉单支血管病变的患者组成，这些患者因急性下壁MI接受了冠状动脉造影。比较了发生休克的患者（休克组）和未发生休克的患者（非休克组）的临床特征、冠状动脉造影结果以及慢性期的左心室功能。此外，进行了多因素逻辑分析以确定急性下壁MI患者休克的独立预测因素。
53例患者均实现了IRL再灌注。休克组LAD心肌桥的发生率、右心室MI的发生率、肌酸磷酸激酶（CPK-MB）峰值、肺毛细血管楔压以及胸部X线片上肺淤血的发生率均显著高于非休克组。心肌桥（p = 0.0018）、右心室MI（p = 0.0374）和CPK-MB峰值（p = 0.0189）被确定为急性下壁MI患者休克的独立预测因素。
本研究提示心肌桥在下壁MI急性期对左心室功能起作用。
