急性无Q波心肌梗死和Q波心肌梗死早期冠状动脉造影的比较

目的　探讨急性无Q波心肌梗死 (ANQMI)和急性Q波心肌梗死 (AQMI)在发病最初 6h内冠状动脉病变的性质、血栓及侧支循环形成情况的不同 ,为进一步治疗提供理论基础。方法　对 5 2例AN QMI患者和 130例AQMI患者在发病 6h内进行选择性冠状动脉造影 ,比较两组在冠状动脉造影所见中的不同特点 ,并对他们的发病年龄、临床症状、心肌酶变化特点等情况进行。结果　与AQMI比较 ,ANQMI发病年龄较高 ,临床中常缺乏特征性的胸痛症状。冠状动脉造影所见中 ,相关的冠状动脉完全性闭塞在ANQ MI组为 2 8 9% (15 / 5 2 ) ,在AQMI组为 86 9% (113/ 130 ) ;ANQMI组血栓存在为 15 1% (8/ 5 2 ) ,AQMI组为73 9% (96 / 130 ) ;ANQMI组侧支循环形成 4 0 4 % (2 1/ 5 2 ) ,AQMI组 13 9% (18/ 130 ) ;ANQMI组多支病变为 5 1 9% (2 7/ 5 2 ) ,AQMI组为 4 0 0 % (5 2 / 130 )。以上 P<0 0 5。结论　与AQMI组比较 ,ANQMI在发病最初 6h内完全性闭塞发生率低 ,血栓存在率低 ,侧支循环较丰富 ,多支病变发生率较高。因此 ,对于ANQ MI早期溶栓治疗可能不会收到理想的效果 ,而应尽早采用其他冠脉介入性治疗

Comparison of coronary angiography between the non-Q-wave and Q-wave acute myocardial infarction

Objective To study the clinical characteristics,frequency of thrombus,and collateral formation in non-Q-wave and Q-wave acute myocardial infarction(AMI).Methods We reviewed the coronary angiograms in 52 patients with non-Q-wave AMI and 130 patients with Q-wave AMI within 6 hours after onset.The patients with non-Q-wave and Q-wave AMI were compared in clinical characteristics,thrombus,and complete vessel occlusion with collaterals.Results Complete occlusion of the affected artery was present in 15 patients (28.9%) with non-Q-wave AMI,and in 113 patients(86.9%) with Q-wave AMI(P=0.002).Thrombus was observed in 8 patients(15.1%) with non-Q-wave AMI,and 96 patients(73.9%)with Q-wave AMI(P=0.001).Collateral formation related with artery was present in 21 patients(40.4%) with non-Q-wave AMI,and 18 patients(13.9%) with Q-wave AMI(P<0.05).Multi-vessel disesase was observed in 27 patients(51.9%) with non-Q-wave AMI,and 52 patients(40.0%) with Q-wave AMI(P<0.05).Conclusion Coronary aniography performed within 6 hours after onset can demonstrate significant differences between non-Q-wave and Q-wave AMI.Non-Q-wave AMI has a lower incidence of complete occlusion and thrombus,but has a higher incidence of collateral formation and multivessel disease.This explains the clinical course of patients with non-Q-wave AMI and may be helpful in the early stage of developing therapeutic strategies.