Ahmar Walid, Lefkovits Jeffrey
Int J Cardiol. 2008 Aug 1;128(1):131-3. doi: 10.1016/j.ijcard.2007.05.053. Epub 2007 Aug 8.
A minority of patients presenting with ST elevation myocardial infarction (STEMI) have angiographically normal coronary arteries. We aimed to assess its incidence, identify possible aetiologies and determine long-term prognosis. We retrospectively analysed 714 consecutive patients presenting with STEMI over a 10-year period (1995 to 2005), and identified 41 patients with angiographically normal coronary arteries. Mean age was 44+/-15 years; the majority were male. Specific diagnoses were made in 13/41 (32%) patients, including peri-myocarditis (11/41) and Takotsubo cardiomyopathy (2/41). No specific diagnosis was made in the remainder and these were considered cryptogenic AMI's. At a mean follow-up of 44+/-30 months, 1 patient with cryptogenic AMI had a non-cardiovascular death and 1 patient required pacing. In conclusion, there is a small but definite incidence of angiographically normal coronary arteries in patients presenting with STEMI. While the eventual aetiology remains uncertain in most patients, long-term outcomes appear favourable.
少数表现为ST段抬高型心肌梗死（STEMI）的患者冠状动脉造影显示正常。我们旨在评估其发生率，确定可能的病因并判断长期预后。我们回顾性分析了1995年至2005年这10年间连续就诊的714例STEMI患者，确定了41例冠状动脉造影正常的患者。平均年龄为44±15岁；大多数为男性。13/41（32%）的患者有明确诊断，包括围心肌炎（11/41）和Takotsubo心肌病（2/41）。其余患者未明确诊断，被视为隐匿性心肌梗死。平均随访44±30个月时，1例隐匿性心肌梗死患者出现非心血管死亡，1例患者需要起搏治疗。总之，STEMI患者中冠状动脉造影正常的发生率虽低但确切存在。虽然大多数患者最终病因仍不确定，但长期预后似乎良好。
