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目的:探讨陈旧性心肌梗死(OMI)并发急性左心衰竭时原梗死区ST段急性抬高的临床特点及意义。方法:选择OMI并发急性左心衰竭时原梗死区ST段急性抬高且在首次发生ST段抬高急性心肌梗死(AMI)时均未采用溶栓、冠状动脉介入治疗(PCI)或冠状动脉搭桥术(CABG)治疗患者21例,均按急性左心衰竭常规处理以及对症治疗。所有患者病情平稳后行择期冠状动脉造影(CAG)检查。结果:随着急性左心衰竭症状的好转,抬高的ST段逐渐回落至等电位线或发生急性左心衰竭前水平,但未出现典型AMI的T波演变,病理性Q波也无明显加深加宽。CAG结果证实所有患者的梗死相关动脉均是完全闭塞的,梗死区的血运完全靠侧支循环提供。冠状动脉3支病变16例(76·2%),2支病变5例(23·8%)。结论:OMI并发急性左心衰竭时其ST段抬高实质是梗死区域残存心肌侧支循环明显减少甚至中断,而非常规意义的冠状动脉急性血栓形成所致的AMI。临床上应按急性左心衰竭常规治疗,不应采取溶栓治疗,适时行完全或部分血运重建。
Objective: To investigate the clinical features and significance of ST elevation acute exacerbation in patients with old myocardial infarction (OMI) complicated with acute left heart failure. Methods: Acute elevation of ST segment in the original infarction area with OMI complicated by acute left heart failure and no thrombolysis, coronary intervention (PCI) or coronary artery bypass graft (PCI) in the first AMI occurred. Twenty-one patients underwent CABG and were treated according to the conventional treatment of left ventricular failure and symptomatic treatment. All patients underwent stable elective coronary angiography (CAG). Results: With the improvement of symptoms of acute left heart failure, the elevated ST segment gradually dropped to the isoelectric line or the level of acute left ventricular failure, but there was no T wave evolution of typical AMI and pathological Q wave did not significantly deepen Widen CAG results confirmed that all patients with infarct-related arteries are completely occluded, the blood supply to the infarct area is entirely provided by the collateral circulation. Three lesions of coronary artery in 16 cases (76.2%), 2 lesions in 5 cases (23.8%). CONCLUSION: The ST-segment elevation in OMI complicated by acute left heart failure is substantially reduced or even interrupted by the remnant myocardial collateral circulation in infarction area rather than the AMI caused by acute coronary thrombosis in the conventional sense. Clinic should be routine treatment of acute left heart failure, thrombolytic therapy should not be taken, timely or complete partial or complete revascularization.