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目的 探讨左冠状动脉解剖形态与左主干(LM)急性心肌梗死(AMI)发生及住院期间死亡的关系.方法 回顾性分析2010年1月至2015年4月于哈尔滨医科大学附属第一医院行冠状动脉造影证实左主干病变的176例患者的临床资料及冠状动脉造影资料,根据是否发生AMI分为LM-AMI组(43例)和LM非AMI组(非AMI组,133例),LM-AMI组根据住院期间死亡情况分为存活组(35例)和死亡组(8例).利用定性比较分析(QCA)软件测量左冠状动脉解剖形态,采用单因素分析及Logistic 回归分析,研究左冠状动脉解剖形态与LM-AMI发生及住院期间死亡的关系.结果 LM-AMI组患者左前降支(LAD)与左回旋支(LCX)夹角小于非AMI组(P＜0.05),而LM直径及长度、LAD及LCX直径、LM与LAD夹角和LM与LCX夹角两组比较,差异均无统计学意义(均P＞0.05);LAD与LCX夹角较小者LM-AMI的发生率明显增加,且LAD与LCX夹角＜79.43°的患者发生LM-AMI的风险是LAD与LCX夹角为79.43°～108.73°患者的3.6倍.LM-AMI存活组与死亡组LM直径及长度、LAD及LCX直径、LM与LAD夹角、LM与LCX夹角及LAD与LCX夹角比较,差异均无统计学意义(均P＞0.05).结论 LM病变患者LAD与LCX夹角与LM-AMI的发生相关,LAD与LCX夹角＜79.43°是LM病变患者发生LM-AMI的独立危险因素,而左冠状动脉解剖形态与LM-AMI患者住院期间死亡无相关性.“,”Objective To discuss the correlation of the left coronary artery morphology and occurrence of acute myocardial infarction (AMI) with left main lesion and in-hospital mortality.Methods This was a retrospective study of clinical information and angiographic data of 176 patients admitted from January 2010 to April 2015 with left main lesion in the First Affiliated Hospital of Harbin Medical University.The patients were divided into left main acute myocardial infarction group and left main non-acute myocardial infarction group,and then the left main AMI group was further divided into the survival group and the deceased group according to the situation of in-hospital death.QCA software was used to measure the anatomical morphology of left coronary artery.The anatomical morphology of left coronary artery between the two groups was compared,and univariate analysis and logistic regression analysis were applied to analyze the factors of AMI occurrence and in-hospital mortality in AMI patients with left main lesion.Results The angle between the left anterior descending artery (LAD) and the left circumflex artery (LCX) of the LM-AMI group was smaller than the non-acute myocardial infarction group (P＜0.05),but there was no significant difference in the diameter and length of left main coronary artery (LM),the diameter of LAD and LCX,the angle between LM and LAD and the angle between LM and LCX between the two groups (P＞0.05).The risk of LM-AMI in patients with the angle between LAD and LCX of ＜ 79.43°is 3.6 times right than patients with the angle between 79.43°～ 108.73°.Between the survival group and the deceased group of AMI patients with left main lesion,there were no significant differences in the diameter and length of LM,the diameter of LAD and LCX,the angle between LM and LAD,the angle between LM and LCX and the angle between LAD and LCX (P＞0.05).Conclusions There was a correlation between the angle between LAD and LCX with the occurrence of LM-AMI in patients with left main lesion.The angle between LAD and LCX of ＜ 79.43° is the independent risk factor of LM-AMI in patients with left main lesion,but there was no correlation between the left coronary artery morphology and in-hospital mortality of patients with left main AMI.