| Objective:Summarize the clinical characteristics,electrocardiogram and coronary artery lesions of patients with complete occlusion of infarct related arteries in acute non-ST-segment elevation myocardial infarction(NSTEMI),and analyze the possible factors of complete occlusion of infarct related arteries and no ST-segment elevation on the electrocardiogram.Further summarize the relatively more characteristic electrocardiogram performance of these patients,and try to find new methods to identify these high-risk NSTEMI patients early.Methods:This study adopted a retrospective analysis.185 patients with NSTEMI who were admitted to the Chest Pain Center of the First Affiliated Hospital of Dali University from September 2019 to December 2020 were used as the research objects.According to the results of coronary angiography(CAG),there were 61 cases in the occlusion group and124 cases in the infarction related artery incomplete occlusion group.The general information,time node of chest pain management,electrocardiogram,left ventricular ejection fraction(LVEF),troponin I(c Tn I),type B-type natriuretic peptide(BNP)and coronary artery disease were compared between the two groups.The global registry of acute coronary events(GRACE)score and SAVE risk score were used for risk stratification.The data was statistically analyzed by IBM SPSS 26.0 software uniformly,and the two-sided test was used.P<0.05 considered the difference to be statistically significant.Results:1.There was no statistically significant difference between the two groups of NSTEMI patients in terms of risk factors(P>0.05).2.Three-vessel involvement is more common in patients with NSTEMI.The most common infarct related artery is the left anterior descending artery,and most of them are proximal lesions.3.In NSTEMI patients,infarction-related arteries are completely occluded,most commonly in the circumflex branch(47.54%).4.The first postoperative troponin I(c Tn I)in the infarction-related artery complete occlusion group was significantly higher than that in the incomplete occlusion group,and the difference was statistically significant(P<0.05).There was no significant difference in first B-type natriuretic peptide and left ventricular ejection fraction(LVEF)between the two groups after surgery(P>0.05).5.Most NSTEMI patients with complete occlusion of infarct related arteries have delay invasive revascularization therapy(>2h).6.NSTEMI patients with complete occlusion of infarct related arteries have relatively specific electrocardiogram findings.7.The GRACE score was used to stratify the two groups of NSTEMI patients,and the difference was not statistically significant(P>0.05).Using the SAVE risk score,the difference was statistically significant(P<0.05).The sensitivity of the SAVE risk score to identify NSTEMI patients with complete occlusion of infarct related arteries was 73.77%and the specificity was 54.84%.Conclusion:Approximately one-third of NSTEMI patients with infarction-related arteries are completely occluded,and these patients are usually delayed in the optimal invasive treatment time.Electrocardiogram has certain misunderstandings in the diagnosis of acute myocardial infarction,and the characteristic electrocardiogram changes can indicate complete occlusion of the coronary arteries.The SAVE risk score can identify 74% of NSTEMI patients with complete occlusion of infarct related arteries.Before coronary angiography,there is no reliable method to identify these patients.At present,better risk stratification tools are still needed to identify such high-risk patients and perform timely revascularization to improve clinical outcomes. |
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