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目的:分析急性前壁心肌梗死合并完全性房室传导阻滞的冠状动脉造影特点。方法:2004-03-2009-03上海交通大学附属第一人民医院心内科共收治急性前壁心肌梗死合并新发完全性房室传导阻滞患者19例,其中14例行冠状动脉造影术,多体位投照观察病变特点,明确梗死相关动脉。并根据主要冠状动脉直径狭窄≥50%的支数,分为左主干病变,单支病变,2支病变,3支病变。结果:14例患者冠状动脉造影均提示冠状动脉严重病变。单支病变1例,2支病变3例,3支病变8例,左主干加3支病变2例。梗死相关动脉12例为左冠状动脉,闭塞部位1例在左主干;9例在左前降支近段,其中4例提供侧支至右冠状动脉远段,2例提供侧支至左回旋支远段;1例在左前降支中段,右冠状动脉变异,开口于闭塞远段;1例在左回旋支近段,提供侧支至右冠状动脉。2例梗死相关动脉为右冠状动脉,闭塞部位1例在近段,为优势型;1例在中段,远段提供侧支至左前降支之第一间隔支。结论:急性前壁心肌梗死合并新发完全性房室传导阻滞患者冠状动脉病变严重,多为多支多处重度狭窄,梗死相关动脉供血范围较广,分别或同时累及第一间隔支动脉、房室结动脉,间接提示临床预后较差。
Objective: To analyze the characteristics of coronary angiography in acute anterior myocardial infarction complicated with complete atrioventricular block. METHODS: From January 2004 to March 2009, 19 patients with acute anterior myocardial infarction and newly developed complete atrioventricular block were enrolled in Department of Cardiology, Shanghai First People’s Hospital Affiliated to Shanghai Jiaotong University, of which 14 underwent coronary angiography Position cast observation of lesions, clear infarct related arteries. According to the main coronary artery diameter stenosis ≥ 50% of the count, divided into left main disease, single disease, 2 lesions, 3 lesions. Results: Coronary angiography in 14 patients all showed severe coronary artery disease. 1 case of single vessel disease, 3 cases of 2 lesions, 3 lesions of 8 cases, left main plus 3 lesions in 2 cases. 12 cases of infarct-related artery were the left coronary artery, 1 case of occlusion was in the left main trunk, 9 cases were in the proximal segment of the left anterior descending artery, 4 of them provided collateral branches to the distal segment of the right coronary artery, and 2 provided lateral branch to the left circumflex branch In the middle segment of the left anterior descending branch, the right coronary artery was variant and opened in the distal segment of the occlusion. One patient was in the proximal segment of the left circumflex artery and provided collateral to the right coronary artery. 2 cases of infarction-related artery for the right coronary artery occlusion in 1 case in the proximal segment, the dominant type; 1 case in the middle and distal segments provide the first branch to the left anterior descending branch. Conclusion: Coronary artery lesions in patients with acute anterior myocardial infarction complicated by new-onset complete atrioventricular block are mostly serious with multiple severe multiple stenosis. The infarction-related artery has a wide range of blood supply, involving the first intercostal artery, Atrioventricular node artery, indirect prognosis poor prognosis.