| BackgroundAccording to whether the ST segment is elevated or not,the acute myocardial infarction(AMI)is divided into two types:ST-segment elevation myocardal infarction(STEMI)and non-ST segment elevation myocardial infarction(NSTEMI).NSTEMI is relative to STEMI.The ST segment changes of these patients included depression of ST segment,no offset of ST segment,and sometimes accompanied by T wave changes,which were classified as non-ST segment elevation in previous clinical practice and scientific research.However,in the electrocardiogram of patients with NSTEMI,there are two objective facts:depression of ST segment and no offset of ST segment.Our group suggested that according to the depression of ST segment,NSTEMI should be further divided into two subtypes of acute ST segment depression myocardial infarction and acute ST segment unoffset myocardial infarction.ObjectiveThe purpose of this study is to further explore the characteristics of coronary angiography in patients with acute ST segment unoffset myocardial infarction on the basis of the previous work of the research group.MethodsStraight into October,2019 to March,2017 in henan province people's hospital emergency interventional treatment of 233 cases of patients with acute myocardial infarction,according to whether st-segment deviation from the baseline can be divided into st-segment elevation group,st-segment depression group and st-segment unoffset group.The unoffset group of the ST segment is taken as the research group.ST segment elevation and ST segment depression group as control group.Collect complete case data,including baseline data(gender,age,drinking history,smoking history,history of hypertension,diabetes,dyslipidemia,EF value,Killip classification),coronary angiography image information(infarction related blood vessels,infarct related site,the number of diseased vascular branches,the classification and the grade of collateral circulation,TIMI flow grade,Gensini score).Statistical methods were used to compare the differences in the characteristics of coronary angiography in the three subgroups.Results1.Of the 233 patients with acute myocardial infarction included in this study,47(20.1%)showed no ST segment deviation,151cases(64.8%)showed ST segment elevation,and 35 cases(15.1%)showed ST segment depression.2.The difference of Killip grade of cardiac function among the three groups was statistically significant.Among them,Killip grade I was higher in the group without ST segment offset(84.9%),ST segment elevation group was the second,and 72.3%),ST segment depression group was the lowest(54.3%).Among the patients with Killip grade ?,? and ?,the proportion of ST segment depression group was the most,the ST segment elevation group was the second,and the ST segment non-offset group was the lowest.3.The characteristics of coronary angiography:there were significant differences among the three groups in infarction-related vessels,infarction-related sites,number of diseased vessels,collateral circulation classification,collateral circulation grade,TIMI blood flow grade and Gensini score.A pairwise comparison was made among the three groups,and the results were as follows:? LCX was the most common infarct-related artery in ST segment unoffset group,and infarct-related lesions were mainly located in distal segment,while left anterior descending artery(LAD)and right coronary artery(RCA)were more common in ST segment elevation group and ST segment depression group,and infarct-related lesions were mainly located in proximal segment,which was significantly different from that in ST segment unoffset group(P<0.05).?ST segment unoffset group and ST segment elevation group showed single vessel disease,there was no difference between the two groups(P<0.05).Most of the patients with ST segment depression showed lesions of two or more vessels,compared with the other two groups,the difference was statistically significant.(P<0.05).?The opening rate of collateral circulation in ST segment unoffset group and ST segment depression group was significantly higher than that in ST segment elevation group,but there was no significant difference between ST segment depression group and ST segment non-offset group.? The proportion of grade 0 TIMI blood flow was the most in the group with unoffset of ST segment and the group with elevation of ST segment.There was no significant difference between the two groups,but the proportion of grade III TIMI blood flow was the most in the group with ST segment depression.Compared with the other two groups,the difference was statistically significant.(P<0.05).? the Gensini scores of ST segment unoffset group,ST segment elevation group and ST segment depression group were 32.1±18.5,43.1 ± 23.0,58.4 ±18.3 respectively.The Gensini score of ST segment depression group was the highest,ST segment elevation group was the second,and ST segment unoffset group was the lowest.Conclusion1.The coronary angiographic features of acute ST segment unoffset myocardial infarction were similar to acute ST segment elevation myocardial infarction.It is obviously different from acute ST segment depression myocardial infarction.2.Acute ST segment unoffset myocardial infarction is a unique type of myocardial infarction.It is suggested that NSTEMI be further classified into acute ST segment unoffset myocardial infarction and acute ST segment depression myocardial infarction. |
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