大于或等于60岁冠状动脉非阻塞性心肌梗死患者的临床特征及预后分析  

Clinical features and prognosis of myocardial infarction with non-obstructive coronary arteries in patients ≥60 years old

作　　者：杨震[1] 王秋林[1] 梁登攀[1] 李文章[1] 蒲静[1] 胡军[1] 冯凯歌 张黎黎[1] 周鹏[1] YANG Zhen;WANG Qiu-lin;LIANG Deng-pan;LI Wen-zhang;PU Jing;HU Jun;FENG Kai-ge;ZHANGLi-li;ZHOU Peng(Department of Cardiology,The First Affiliated Hospital of Chengdu Medical College,Chengdu 610500,China)

机构地区：[1]成都医学院第一附属医院心内科

出　　处：《岭南心血管病杂志》2019年第5期489-494,共6页South China Journal of Cardiovascular Diseases

基　　金：四川省科技厅基金资助项目（项目编号：2016SZ0052）

摘　　要：目的探讨≥60岁冠状动脉非阻塞性心肌梗死(myocardial infarction with non-obstructive coronary arteries,MINOCA)患者的临床特征及预后分析。方法选取2010年6月至2016年6月就诊于成都医学院第一附属医院心内科发病24h内的急性心肌梗死(acute myocardial infarction,AMI)患者242例,根据冠状动脉造影检查结果,共计有<60岁MINOCA患者67例,≥60岁MINOCA患者42例,并随机选取同期≥60岁冠状动脉阻塞性心肌梗死(myocardial infarction associated with obstructive coronary artery disease,MI-CAD)患者133例。比较<60岁MINOCA患者、≥60岁MINOCA患者、≥60岁MI-CAD患者的临床资料,同时观察预后差异。结果与<60岁MINOCA患者相比,≥60岁MINOCA患者年龄、收缩压、舒张压、肌酐、尿酸、白细胞计数更高,三酰甘油、胆固醇、低密度脂蛋白胆固醇浓度更低,差异有统计学意义(均P<0.05)。与≥60岁MI-CAD患者相比,≥60岁MIN.OCA患者年龄更年轻,三酰甘油、胆固醇、低密度脂蛋白胆固醇浓度更低,差异有统计学意义(均P<0.05)。与<60岁MINOCA患者相比,≥60岁MINOCA患者心肌炎病因更少(23.9%vs.4.8%,P=0.009);两组患者其他病因比较,差异无统计学意义(均P>0.05)。与<60岁MINOCA患者相比,≥60岁MINOCA患者合并脑梗死比例更高,差异有统计学意义(10.4%vs.26.2%,P=0.031);与≥60岁MI-CAD患者相比,≥60岁MINOCA患者合并高脂血症更少,差异有统计学意义(47.4%vs.26.2%,P=0.015)。≥60岁MINOCA组患者住院时间较<60岁MINOCA组患者更长,较≥60岁MI-CAD更短,差异有统计学意义(P<0.05)。≥60岁MINOCA组患者全因死亡率与<60岁MINOCA组、≥60岁MI-CAD组患者相比,差异无统计学意义(均P>0.05)。结论与<60岁MINOCA患者相比,≥60岁MINOCA患者有更多的心血管危险因素,患者近期预后较差,远期全因死亡趋势更高。Objectives To investigate the clinical features and prognosis of myocardial infarction with non-obstructive coronary arteries(MINOCA)in patients ≥60 years old.Methods A total of 242 patients with acute myocardial infarction(AMI)from June 2010 to June 2016 in The First Affiliated Hospital of Chengdu Medical College,including 67 patients with MINOCA aged <60 years old,42 patients with MINOCA aged ≥60 years old,and 133 patients with myocardial infarction associated with obstructive coronary artery disease(MI-CAD)aged ≥60 years old in the same period were randomly selected.Clinical data and differences in prognosis of <60-year-old MINOCA patients,≥60-year-old MINOCA patients and ≥60-year-old MI-CAD patients were observed and compared.Results Compared with <60-year-old MINOCA patients,age,systolic blood pressure,diastolic blood pressure,creatinine,uric acid and white blood cell count were significantly higher in ≥60-year-old MINOCA patients,but concentrations of triglyceride,cholesterol and low-density lipoprotein-cholesterol(LDL-C)were significantly lower(all P<0.05).Compared with ≥60-year-old MI-CAD patients,≥60-year-old MINOCA patients were younger and had lower concentrations of triglycerides,cholesterol,and LDL-C(all P<0.05).The etiology of myocarditis in patients with MINOCA aged≥60 years was less than that of patients with MINOCA aged<60 years(23.9% vs.4.8%,P=0.009),while there were no significant differences in other etiologies(all P>0.05).Percentage of ≥60-year-old MINOCA patients combined with cerebral infarction were significantly higher than that of <60-year-old MINOCA patients(26.2% vs.10.4%,P=0.031).Percentage of ≥60-year-old MINOCA patients combined with hyperlipidemia was significantly lower than that of ≥60-year-old MI-CAD patients(26.2% vs.47.4%,P=0.015).Hospitalization duration of ≥60-year-old MINOCA patients was significantly longer than that of <60-year-old MINOCA patients,and significantly shorter than that of ≥60-year-old MI-CAD patients(P<0.05).There was no significa

关 键 词：心肌梗死 冠状动脉 临床特征 全因死亡 

分 类 号：R542.22[医药卫生—心血管疾病]