冠状动脉非阻塞性心肌梗死患者的临床特征、治疗以及院内结局分析  

Clinical features,treatment and in-hospital outcomes in patients with myocardial infarction with non-obstructive coronary arteries

作　　者：汤玮 胡荣 赵冬婧 程国杰 徐勇[2] Tang Wei;Hu Rong;Zhao Dongjing;Cheng Guojie;Xu Yong(Department of Cardiology,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China;不详)

机构地区：[1]首都医科大学大兴教学医院心内科,北京102600 [2]解放军总医院心血管医学部,北京100853

出　　处：《中国循证心血管医学杂志》2022年第4期447-450,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：北京市科技计划项目(Z171100001017243)。

摘　　要：目的 探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特征、治疗及院内结局情况,为MINOCA患者制定针对性治疗策略以及预后管理提供参考依据。方法 回顾性分析首都医科大学大兴教学医院于2017年1月至2020年12月确诊为急性心肌梗死并在24 h内行急诊冠状动脉(冠脉)造影的患者1980例,根据冠脉造影结果分为MINOCA组和冠脉阻塞性心肌梗死(MI-CAD)组,比较两组的临床特征、治疗及院内结局情况。结果 MINOCA组患者158例,MI-CAD组患者1822例。与MI-CAD组相比,MINOCA组女性患者占比偏高,发病年龄更低,STEMI患者占比偏低,合并吸烟、糖尿病及高脂血症史的患者比例较低。MINOCA组患者的三酰甘油、总胆固醇、低密度脂蛋白胆固醇、空腹血糖、脑钠肽(BNP)、肌酸激酶、肌酸激酶同工酶、肌钙蛋白水平均明显低于MI-CAD组患者,左心室射血分数(LVEF)明显高于MI-CAD组患者(P<0.05)。MINOCA组患者双联抗血小板聚集治疗(DAPT)、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)以及康复治疗的比例均偏低(P<0.05),出血发生率及心力衰竭发生率偏低(P<0.05),两组患者在总住院时间、全因死亡率、心血管死亡率、恶性心律失常方面相比无统计学意义(P>0.05)。结论 MINOCA患者发病年龄偏小,且传统冠心病危险因素较少,但住院期间主要不良心血管事件发生率并不低于MI-CAD患者,在规范化药物治疗及心脏康复治疗方面需要进一步加强。Objective To investigate the clinical features,treatment and in-hospital outcomes in patients with myocardial infarction with non-obstructive coronary arteries(MINOCA),and provide a reference for target therapeutic strategy in MINOCA patients.Methods The patients with myocardial infarction(AMI,n=1980)received emergency coronary angiography within 24 h were retrospectively analyzed in Daxing Teaching Hospital of Capital Medical University from Jan.2017 to Dec.2020.According to results of coronary angiography,the patients were divided into MINOCA and myocardial infarction-coronary artery disease group(MI-CAD group).The clinical features,treatment and in-hospital outcomes were compared between 2 groups.Results There were 158 cases in MINOCA group and 1822 cases in MI-CAD group.Compares with MI-CAD group,the percentage of female patients was higher,age of disease onset was younger,proportion of STEMI patients was lower,and percentage of patients with smoking,diabetes and hyperlipidemia history was lower in MINOCA group.The levels of triglyceride(TG),total cholesterol(TC),low-density lipoprotein-cholesterol(LDL-C),fasting plasma glucose(FPG),brain natriuretic peptide(BNP),creatine kinase(CK),creatine kinase-MB isoenzyme(CK-MB) and cardiac troponin were significantly lower,and left ventricular ejection fraction(LVEF) was significantly higher in MINOCA group than those in MI-CAD group(P<0.05).In MINOCA group,the proportions of patients treated with dual anti-platelet therapy(DAPT),β-receptor blocker,angiotensin converting enzyme inhibitor(ACEI)/angiotensin receptor blocker(ARB) and rehabilitation treatment were lower(P<0.05),and incidence rates of bleeding and heart failure were lower(P<0.05).The difference in the total hospital length of stay,all-cause mortality,cardiovascular mortality and malignant arrhythmia had no statistical significance between 2 groups(P>0.05).Conclusion MINOCA patients are younger and have fewer traditional risk factors for coronary heart disease,but the incidence rates of major adverse cardio

关 键 词：心肌梗死 冠状动脉非阻塞 临床特征 院内结局 

分 类 号：R542.22[医药卫生—心血管疾病]