ANGIOGRAPHIC FINDINGS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH PREVIOUS BYPASS-SURGERY - EXPLANATIONS FOR SMALLER INFARCTS IN THIS GROUP COMPARED WITH CONTROL PATIENTS
ANGIOGRAPHIC FINDINGS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH PREVIOUS BYPASS-SURGERY - EXPLANATIONS FOR SMALLER INFARCTS IN THIS GROUP COMPARED WITH CONTROL PATIENTS
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DOI：
10.1161/01.cir.71.4.693
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发表时间：
1985-01-01
期刊：
影响因子：
37.8
通讯作者：
THEROUX, P
中科院分区：
文献类型：
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作者：
CREAN, PA;WATERS, DD;THEROUX, P
我院急性心肌梗死患者既往冠状动脉搭桥术（CABS）的发生率在6年内从2.3%上升到11.2%。比较了52例对照组和52例连续2个月以上急性心肌梗死患者的CT大小和血管造影确定的梗死原因。在他们接受了CABS之后。两组的基线特征相似，但CABS后组中既存Q波的发生率较高（22 vs. 10; P < 0.05）。与对照组相比，CABS后组的心肌梗死面积指数较小：肌酸激酶（CK）峰值水平（IU/l）为1113 . ±. 1094（平均值±）SD）与1824 . ±. 1932（P < 0.01），CK-MB峰值（IU/l）173 ± 0.01。230对272 +-。332（P < 0.02），ST段抬高峰值总和（mm）3.5。±。4.8 vs. 8.2 .+-。9.9（P < 0.005），第7-10天的QRS评分为1.9 ± 1.0。3.0 vs. 4.3 .+-。3.4（P < 0.001）。心肌梗死后左心室射血分数在CABS后组中较高（53 . ±. 13%）与对照组（47 . ±. 12%; P < 0.05）。CABS术后患者和对照组患者中梗死区动脉完全闭塞的发生率相似（33 vs. 27），1支、2支和3支血管疾病（动脉加移植物）的发生率也相似。在27例CABS后患者和23例对照患者中发现了向梗死区的侧支血流。CABS术后患者和对照组患者的梗死原因分别为7例和22例（P < 0.001），15例和4例（P < 0.01），8例和1例（P < 0.05）。此外，8例移植物和动脉闭塞的患者在手术前有闭塞的自体血管。既往接受过CABS的患者，由于梗死病灶远端存在较少危害的心肌，因此心肌梗死较小，残余左心室功能较好。
The incidence of previous coronary artery bypass surgery (CABS) in patients with acute myocardial infarction admitted to our hospital has risen from 2.3% to 11.2% in 6 yr. Infarct size and the angiographically determined cause of infarction were compared in 52 control patients and in 52 consecutive patients with acute myocardial infarction at least 2 mo. after they had undergone CABS. Baseline characteristics were similar in both groups except for a higher incidence of preexisting Q waves in the post-CABS group (22 vs. 10; P < 0.05). Indexes of myocardial infarct size were smaller in the post-CABS group compared with those in control patients: peak creatine kinase (CK) level (IU/l) 1113 .+-. 1094 (mean .+-. SD) vs. 1824 .+-. 1932 (P < 0.01), peak CK-MB level (IU/l) 173 .+-. 230 vs. 272 .+-. 332 (P < 0.02), peak summed ST segment elevation (mm) 3.5 .+-. 4.8 vs. 8.2 .+-. 9.9 (P < 0.005), and QRS score on days 7-10, 1.9 .+-. 3.0 vs. 4.3 .+-. 3.4 (P < 0.001). Postinfarction left ventricular ejection fraction was higher in the post-CABS group (53 .+-. 13%) compared with that in control patients (47 .+-. 12%; P < 0.05). The incidence of total occlusion of the artery to the infarct zone was similar in the post-CABS and control patients (33 vs. 27), as was the incidence of 1-, 2- and 3-vessel disease (artery plus graft). Collateral blood flow to the infarct zone was found in 27 post-CABS patients and in 23 control patients. The cause of infarction in post-CABS and control patients was a lesion in a major artery proximal to all branches in 7 vs. 22 (P < 0.001), a lesion in a diagonal or marginal artery in 15 vs. 4 (P < 0.01), and a lesion in a distal small vessel in 8 vs. 1 (P < 0.05). In addition, 8 patients with graft and artery occlusion had an occluded native vessel before surgery. Patients who have undergone previous CABS have smaller myocardial infarcts and better residual left ventricular function due to the presence of less jeopardized myocardium lying distal to the infarct-producing lesion.