급성심근경색증 환자의 관상동맥 및 좌심실 조영 소견

Abstract

Background Results of recent studies have suggested that the extent and severity of coronary artery disease and the degree of left ventricular dysfunction are two major factors influencing survival in patients with acute myocardial infarction. Although non-invasive modalities including exercise stress electrocardiography, echocardiography and nuclear cardiologic techniques can predict the prognosis of patients with acute myocardial infarction to an extent, coronary angiography is still the best modality for exact evaluation of the severity and the extent of coronary artery disease.

Methods A review was done from January, 1985, to August, 1993, on 631 patients with acute myocardial infarction who underwent coronary angiography with or without left ventricular angiography within 30 days after onset of acute myocardial infarction at Yonsei University Severance Hospital.

Results 1) The mean age of the 631 patients was 55.2 years(23-82 years). Five hundred thirty three(84.5%) were males and 98(15.5%) were females. The prevalences of coronary artery disease were high in the 5th decade in males and in the 6th decade in females.

2) The major risk factors were cigarette smoking(69.6%), hypertension(34.9%), diabetes mellitus(18.9%), and hypercholesterolemia(12.3%). Cigarette smoking was statistically more frequent in males and hypertension was more frequent in female.

3) Of the 631 patients studied, 570 patients(90.3%) had Q wave myocardial infarction and 61 patients(9.7%) had a non-Q wave myocardial infarction. 33 patients(5.2%) had a history of previous myocardial infarction.

4) The coronary angiogram showed 25 patients(4.0%) had normal coronary anatomy and 29 patients(4.6%) had minimal coronary vessel lesions. Lesions greater than 50% were confined to one major artery in 309 patients(49.0%), whereas two-and three-vessel disease were found in 179(28.3%) and 83(13.1%) patients respectively.

5) The normal or minimal lesion coronary anatomy and one-vessel disease were significantly frequent in patients under 40 years of age. However, multi-vessel disease was significantly more frequent in patients over 40 years of age.

6) The patients who had a history of cigarette smoking often had more normal or minimal lesion coronary anatomy, one vessel disease and less multi-vessel disease, compared with those without a history of cigarette smoking. The patients with hypertension had more multi-vessel disease and less normal or minimal lesion coronary anatomy, one vessel disease. The patients with diabetes mellitus had less one vessel disease and more multi-vessel disease.

7) According to the site of infarction, anterior myocardial infarction was associated with more prevalence in normal or minimal lesion coronary anatomy, one vessel disease, inferior myocardial infarction was associated with more prevalence in multi-vessel disease.

8) The infarct related artery was the left anterior descending artery in 5.3.7%, the right coronary artery in 35.9%, the left circumflex artery in 10.3%. Additionally, there was one case of anterior myocardial infarction associated with the left main coronary artery occlusion.

9) With the passage of time, there was a decrease of total occlusion in all cases whether thrombolytic therapy was administered or not. The patients with thrombolytic therapy had a lower total occlusion rate of infarct related artery compared with those without thrombolytic therapy.

10) The left ventricular ejection fraction was higher in the patients with non-Q wave infarction than in those with Q wave infarction. The left ventricular ejection fraction was higher in the patients with thrombolytic therapy in comparison with those who did not receive thrombolytic therapy.

Conclusion The coronary angiographic findings of patients with acute myocardial infarction showed higher prevalence of one vessel disease, and more frequent onset of myocardial infarct under 40 years of age with normal or minimal lesion coronary anatomy. Thrombolytic therapy administered to patients with acute myocardial infarction resulted in the beneficial effects of decreased total occlusion rate of the infarct related artery and improved left ventricular function.