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目的 探讨急性心肌梗死(AMI)后不同时间发生心房颤动(Af)的临床意义及机制。方法 按AMI后12h内和大于12h发生Af者,将106例有Af的AMI患者分为早期组(48例)和后期组(58例),回顾性分析急性心肌梗死后不同时期心房颤动发生者的超声心动图、冠状动脉造影(CAG),急诊经皮腔内冠动脉成形术(PTCA)和静脉溶栓的临床资料。结果 统计学显示两组的年龄(65.7±12.6岁vs 68.1±10.2岁)、左心房内径(38.1±3.26mm vs 39.O±4.35mm)无显著性差别(P>O.05)。早期组的左心室射血分数(O.58±O.12 vs O.40±O.10,P 0.05). Left ventricular ejection fraction (O.58 ± O.12 vs O.40 ± O.10, P <0.05) and Killip grading in early stage were significantly better than those in late stage. In the latter group, the incidence of coronary artery disease (36.4% vs 16.5%, P <0.01) and anterior wall infarction (40.O% vs 17.6%, P <0.01) were higher than those in the early stage. In the early group, the rate of vascular recanalization was as high as 73.6% and in the late group was only 16.6% (P <0.01). The rate of death within 30 days was 8.O% and that of the latter was 23.3% (P <0.01). Conclusions The rate of revascularization in the early stage of AMI complicated with Af is high, while the cardiac function of the latter stage is significantly reduced. The incidence of the three branches of coronary artery and the anterior wall infarction is higher than that in the early stage. This suggests that the mechanism of AMI complicated with Af may be different at different stages after the onset of AMI.