Objective To explore the relationships between electrocardiogram ischemic classification and target vessel lo-cation and stenosis degree of acute myocardial infarction(AMI). Methods A total of 80 AMI patients with an onset time of less than 12 h were divided into the grade 2 ischemic group(n=50)and the grade 3 ischemic group(n=30)according to Birnbaum electrocardiogram ischemic classification. The target vessel localization and stenosis degrees were determined with CAG diameter visual method. Levels of CK-MB, cTnI and BNP, left ventricular end diastolic diameter(LVEDd)and ejection fraction (LVEF)were compared. The incidence of major adverse cardiac events(MACEs)after 6 months of follow-up was recorded. Results The baseline level and elevation of CK-MB,cTnI and BNP in the grade 3 ischemia group were greater than those in the grade 2 ischemia group, and the difference was statistically significant(P<0.05), but LVEDd and LVEF values in the two groups were not significantly different(P>0.05). The rates of lesions in the left anterior descending branch,left main coronary artery and left main coronary artery bifurcation in the grade 3 ischemia group were higher. The grade 2 ischemia group was domi-nated by lesions in the circumflex branch,the right coronary artery and the branches. The average number of target lesions and the degree of stenosis of the lumen in the grade 3 ischemia group were significantly larger or higher than those in the grade 2 is-chemia group,and the difference was statistically significant(P<0.05). The incidence of MACEs in the grade 3 ischemic group increased,and the difference was statistically significant(P<0.05).Conclusion The electrocardiogram ischemic classification can evaluate the target vessel location and stenosis of AMI patients,and it is of important clinical value.

Objectives To assess the value of lead aVR in diagnosing the severity of coronary artery disease in non-STelevation acute coronary syndrome(ACS) compared with coronary angiographic outcome. Methods General information, electrocardiogram, color doppler echocardiography and coronary angiographic outcomes of 625 cases with non-STelevation ACS were analyzed. Results Among 625 patients with non-ST-elevation ACS, 537 had no ST-elevation in aVR, 58 had minor(0.05-0.1 mm) ST-elevation in aVR and 30 had major(0.1 mm) ST-elevation in aVR, their left ventricular ejection fraction(LVEF) were 53.6% ±7.2%, 50.2% ±6.8% and 48.2% ±6.4%, respectively(P =0.003); malignant arrhythmia(ventricular tachycardia or ventricular fibrillation) rates were 3.4%,8.6% and 13.3%, respectively(P = 0.008); mortality rates were 2.2%, 5.2% and 10%, respectively(P =0.026); incidences of left main and(or) three-vessel disease(LM / 3-vd) were 24.8%, 37.9% and 56.7%, respectively(P0.0005). Conclusions STelevation in aVR can be useful in the early identification of LM / 3-vd in patients with non-ST-elevation ACS, and it should be highly valued.

目的:研究C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的临床诊断价值.方法:取我院2012年以来收治的经冠状动脉造影后确诊为冠心病的100例患者作为观察组,同时取100位同年龄段健康体检志愿者作为对照组,两组全部进行C反应蛋白、脂蛋白(a)及血清尿酸的检测并对比化验结果.结果:观察组患者C反应蛋白、脂蛋白(a)及血清尿酸化验结果明显高于对照组志愿者,且化验结果与患者冠状动脉病变范围关系成正相关,观察组患者异常率较高.结论:C反应蛋白、脂蛋白(a)及血清尿酸的检测对冠心病的诊断具有十分重要的意义.

目的:观察合并完全性右束支传导阻滞(CRBBB)的急性前壁心肌梗死(AAMI)的临床特点.方法:回顾性分析316例AAMI患者,将合并新发CRBBB患者43例作为观察组,50例不合并束支传导阻滞的AAMI患者作为对照组,分析两组患者一般资料、冠状动脉造影、心脏彩超、Killip分级以及血液生化指标的差异.结果:两组患者一般情况及并发症比较无明显差异(P>0.05),平均Killip分级观察组为1.63±0.93,对照组为1.22±0.62(P=0.013).左室射血分数(LVEF)观察组为(41.6±4.2)%,对照组为(48.2±4.4)%(P=0.001).肌酸激酶同工酶(CKMB)峰值观察组为(276.6±63.5)U/L,对照组为(171.5±29.4)U/L(P<0.001).肌钙蛋白I峰值(TNI)观察组为(11.01±2.39)μg/L,对照组为(6.03±1.52)μg/L(P<0.001).冠脉造影结果观察组前降支近段病变(26/43,60.5%),对照组前降支近段病变(15/50,30%)(P=0.003).结论:合并CRBBB的AAMI患者多为前降支近段病变,心肌梗死面积更大、心功能更差,应对这些患者尽早采取再灌注治疗以改善预后.

在急性心肌梗死(acute myocardial infarction,AMI)患者及时开通梗死相关血管(IRA)是目前公认的改善心肌梗死预后的有效方法.临床上非Q波和Q波心肌梗死造影上有血栓征象者分别高达75%和90%以上,特别是溃疡病变、带血栓病变在介入治疗中更容易发生斑块和血栓的脱落,引起远端血栓栓塞,形成"无复流"或"慢血流",一旦远端血栓栓塞,无论是冠状动脉内应用尿激酶、糖蛋白(GP)Ⅱ b/Ⅲa受体拮抗剂等都不能显著改善患者近期和远期临床预后.