中文摘要：

目的：冠状动脉（冠脉）急性血栓完全闭塞一般表现为ST段抬高型心肌梗死,但临床发现部分冠脉急性闭塞并未伴有相应导联的ST段抬高,影响此类患者的评估及治疗决策。本文拟探讨此类患者的临床特征,提高其早期识别能力。方法：收集我院心血管内科冠心病监护病房急性心肌梗死无显著ST段抬高,且冠脉影像分析为急性单支冠脉完全血栓闭塞的患者40例,另选取同期住院的典型ST段抬高型心肌梗死40例及典型非ST段抬高型心肌梗死40例作为对照。比较3组患者的胸痛持续时间,高峰心肌损害标记物肌钙蛋白Ⅰ、冠脉造影发现及介入诊治结果,以及严重临床事件及死亡率。结果：无明显ST段抬高的急性冠脉完全闭塞心肌梗死患者冠脉病变多以回旋支、较大的对角支或钝缘支闭塞为主,占比72.5%,右冠后三叉后左室后支闭塞占10%,此部分患者梗死部位在后侧、高侧及后壁,此部位心电图检测敏感性差,且患者梗死面积相对较小,无相应ST段抬高,小部分患者为小右冠闭塞造成的孤立性右室梗死和左主干闭塞。无明显ST段抬高的急性单支冠脉完全闭塞心肌梗死患者胸痛持续时间类似典型ST段抬高型心肌梗死,但明显长于典型非ST段抬高型心肌梗死;无明显ST段抬高的急性单支冠脉完全闭塞心肌梗死心肌损害标记物显著高于典型非ST段抬高型心肌梗死,但同时亦低于典型ST段抬高型心肌梗死。无明显ST段抬高的急性单支冠脉完全闭塞总体预后好于典型ST段抬高型心肌梗死及典型非ST段抬高型心肌梗死。结论：无明显ST段抬高的急性单支冠脉完全闭塞心肌梗死多为供血后侧、高侧及后壁的冠脉急性闭塞为主,其临床特征类似ST段抬高型心肌梗死,对缺乏ST段抬高但缺血时间显著延长,心肌损害标记物显著升高的心肌梗死患者,应高度警惕存在急性单支冠脉完全闭塞,并尽早行血?

英文摘要：

Objective：Though most patients with ST-segment elevation myocardial infarction are due to the acute coronary thrombotic occlusion,some patients with acute coronary occlusion was not accompanied by a corresponding leads of ST elevation.Method：This article’s aim is to improve the clinical diagnosis and treatment early of acute myocardial infarction patients without ST-segment elevation due to coronary artery complete occlusion through investigating their clinical characteristics.We collected 40 acute myocardial infarction patients without STsegment elevation due to single coronary artery complete thrombosis occlusion from the coronary intensive care unit in our hospital,and collected other 40 typical acute ST-segment elevation myocardial infarction and typical acute non ST-segment elevation myocardial infarction as controls.We analyzed the chest pain duration,peak myocardial damage markers troponin I,coronary angiography and coronary interventional treatment results,and observed the serious clinical events and cardiac mortality in the three groups.Result：We found compared to the typical ST-segment elevation myocardial infarction and non ST-segment elevation myocardial infarction patients,the target lesion coronary mainly were left circumflex artery,diagonal branch or obtuse marginal branch,which accounting for72.5%,and 10%lesion coronary was posterior branches of left ventricular in the acute myocardial infarction patients without ST segment elevation due to coronary artery complete occlusion.These coronary artery mainly distributed to the rear,back or high side of left ventricular.To this parts,the ECG detection sensitivity was poor,and the infarct area was relatively small,so there were no corresponding ST segment elevation.And in a small number of patients,the lesion coronary artery was the proximal non-dominant right coronary which cause the isolated right ventricular infarction or the left main coronary artery.The acute myocardial infarction patients without ST-segment elevation due to single coronary