Dote K, Sato H, Tateishi H, Uchida T, Ishihara M, Sasaki K
Department of Cardiology, Hiroshima City Hospital.
J Cardiol. 1989 Sep;19(3):729-39.
The clinical features of 124 patients with incompletely obstructed infarct-related arteries during the early stages of myocardial infarction (Group 1) were compared with those of 212 patients having completely occluded coronary arteries (Group 2). Coronary angiography was performed within 12 hours after onset of symptoms in all cases. Patients treated with emergency coronary angioplasty were excluded from the study. Thrombolytic therapy, performed in both groups whenever intracoronary thrombi were detected, was successful in 61% of Group 2. Results were as follows: 1. In Group 1, three-vessel disease was observed more frequently than one-vessel disease (49 vs 27%, p less than 0.005). 2. The peak level of CPK was higher in Group 2 (p less than 0.001), and left ventricular ejection fraction was higher in Group 1 (66 +/- 16 vs 56 +/- 14%, p less than 0.01). 3. Either significant ST elevation or the Q wave was more commonly absent in Group 1 (31 vs 12%, p less than 0.01; 49 vs 12%, p less than 0.001). 4. Improvement of ejection fraction was observed in Group 1, but not in Group 2 even if the infarct-related artery was recanalized within six hours. 5. Extension of an infarct area was more common in Group 1 compared to Group 2 which was successfully treated with thrombolytic therapy (12 vs 3.9%, p less than 0.05). 6. The most important cause of death was extension of an infarct area in Group 1 and pump failure in Group 2, though hospital mortality rates were similar in both groups. It was concluded that patients with myocardial infarction having incompletely obstructed infarct-related coronary arteries have better left ventricular function and higher rates of non-Q myocardial infarction compared with those who had completely obstructed coronary arteries. However, extensions of infarcted areas commonly occur in these patients.
将124例心肌梗死早期梗死相关动脉未完全闭塞患者（第1组）的临床特征与212例冠状动脉完全闭塞患者（第2组）的临床特征进行比较。所有病例均在症状发作后12小时内进行冠状动脉造影。接受急诊冠状动脉血管成形术治疗的患者被排除在研究之外。两组一旦检测到冠状动脉内血栓均进行溶栓治疗，第2组溶栓成功率为61%。结果如下：1. 在第1组中，三支血管病变比单支血管病变更常见（49%对27%，p<0.005）。2. 第2组肌酸磷酸激酶（CPK）峰值水平更高（p<0.001），第1组左心室射血分数更高（66±16%对56±14%，p<0.01）。3. 第1组中显著ST段抬高或Q波更常见缺如（31%对12%，p<0.01；49%对12%，p<0.001）。4. 第1组观察到射血分数改善，而第2组即使梗死相关动脉在6小时内再通也未观察到射血分数改善。5. 与成功接受溶栓治疗的第2组相比，第1组梗死面积扩大更常见（12%对3.9%，p<0.05）。6. 尽管两组医院死亡率相似，但第1组死亡的最重要原因是梗死面积扩大，第2组是泵衰竭。得出结论，与冠状动脉完全闭塞的患者相比，梗死相关冠状动脉未完全闭塞的心肌梗死患者左心室功能更好，非Q波心肌梗死发生率更高。然而，这些患者梗死面积扩大常见。
