Haze K, Nonogi H, Fukami K, Hiramori K, Sumiyoshi T, Kawaguchi M, Saito M, Ueshima K
Department of Internal Medicine, National Cardiovascular Center.
Kokyu To Junkan. 1991 Jan;39(1):83-8.
To know whether the pathogenesis of impending myocardial infarction(IMI) could be predicted by the direction of ST segment shifts during an ischemic chest pain, we studied 62 patients with IMI and undergoing emergent coronary angiography(CAG). They were selected from a consecutive number of 474 patients with unstable angina. IMI was defined when patients had more than 2 episodes of chest pain at rest under intensive pharmacological interventions after their CCU admission, and at least one of those was not relieved by nitroglycerin given intravenously. They were divided into 2 groups according to ST segment shifts during chest pain; 35 patients with ST elevation (G-1) and 27 patients with ST depression (G-2). The time of CAG was individually determined in each patient according to the severity of illness. Those with acute MI within 3 months before the study and 24 hours following the chest pain just before CAG were excluded from the study. New onset angina accounted for 49% in G-1 and 4% in G-2(p less than 0.01). Average history length of IMI, frequency of symptoms after CCU admission, and interval from the last symptom to CAG were similar in each groups. Single vessel disease was more predominant in G-1 than in G-2 (54% vs 11% p less than 0.01). Intracoronary thrombus(IT) in an ischemia related artery(IRA) was found in 97% of G-1 and 22% of G-2(p less than 0.001), while complex lesions(CL) proposed by Ambrose as another genesis of IMI were in 26% of G-1 and 74% of G-2(p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
为了了解是否可以通过缺血性胸痛时ST段偏移的方向来预测急性心肌梗死（IMI）的发病机制，我们研究了62例患有IMI且正在接受急诊冠状动脉造影（CAG）的患者。他们是从连续的474例不稳定型心绞痛患者中挑选出来的。IMI的定义为患者在CCU入院后，经过强化药物干预仍有超过2次静息胸痛发作，且至少有一次静脉注射硝酸甘油后未缓解。根据胸痛时ST段的偏移情况将他们分为两组：35例ST段抬高患者（G-1组）和27例ST段压低患者（G-2组）。根据病情严重程度为每位患者单独确定CAG的时间。研究前3个月内发生急性心肌梗死以及CAG前胸痛后24小时内发生急性心肌梗死的患者被排除在研究之外。新发心绞痛在G-1组中占49%，在G-2组中占4%（p<0.01）。每组中IMI的平均病史长度、CCU入院后症状发作频率以及从最后一次症状到CAG的间隔时间相似。单支血管病变在G-1组中比G-2组更常见（54%对11%，p<0.01）。在G-1组中，97%的缺血相关动脉（IRA）发现有冠状动脉内血栓（IT），在G-2组中为22%（p<0.001），而安布罗斯提出的作为IMI另一起因的复杂病变（CL）在G-1组中占26%，在G-2组中占74%（p<0.001）。（摘要截断于250字）
