老年急性心肌梗死后冠状动脉微循环障碍患者的临床特点及远期预后的研究  

Clinical characteristics and long-term outcome of elderly coronary microcirculation disorder patients after AMI

作　　者：王岚[1] 马玉良[1] 王伟民[1] 朱天刚[1] 靳文英[1] 赵红[1] 曹成富[1] 王静[1] Wang Lan;Ma Yuliang;Wang Weimin;Zhu Tiangang;Jin Wenying;Zhao Hong;Cao Chengfu;Wang Jing(Department of Cardiology,Peking University People's Hospital,Research Center for Cardiovascular Translationa,Beijing 100044,China)

机构地区：[1]北京大学人民医院心血管内科急性心肌梗死早期预警和干预北京市重点实验室心血管转化医学研究中心,100044

出　　处：《中华老年心脑血管病杂志》2022年第6期603-606,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：首都卫生发展科研专项项目(首发2020-1-4031)。

摘　　要：目的分析急性心肌梗死(AMI)后冠状动脉微循环障碍(CMD)的年龄≥75岁患者的临床特点及预后。方法选择2016年6月~2021年9月北京大学人民医院心血管内科收治并于住院期间完成心肌声学造影的AMI患者197例,纳入合并CMD患者115例(58.4%)为研究对象,根据AMI发病时年龄分为≥75岁组20例和对照组(年龄<75岁)95例。收集2组基线资料,测量左心室舒张末期内径(LVEDD)、LVEF、整体长轴应变(GLS)、室壁运动评分(WMSI)、节段性室壁运动异常(RWMA)以及心肌灌注指数(MPI)。随访8(3,13)个月,观察2组患者主要不良心血管事件(MACE)。结果与对照组比较,≥75岁组女性(50.0%vs 18.9%,P=0.003)、非ST段抬高型心肌梗死(NSTEMI)比例明显升高(40.0%vs 15.8%,P=0.014),2组入院时Killip分级比较,有统计学差异(P=0.016)。2组LVEDD、LVEF、GLS、RWMA、WMSI及MPI比较,差异无统计学意义(P>0.05)。校正性别、Killip分级及NSTEMI后,≥75岁组患者再住院(OR=4.017,95%CI:1.255~12.861,P=0.019)、心力衰竭(OR=4.179,95%CI:1.296~13.470,P=0.017)及总MACE发生率(OR=2.594,95%CI:1.056~6.370,P=0.038)明显高于对照组。结论AMI后年龄≥75岁老年CMD患者左心收缩功能与运动受损,但与年龄<75岁患者无差异。尽管如此,AMI后年龄≥75岁老年CMD患者远期MACE仍显著增加。Objective To analyze the clinical characteristics and long-term outcome of elderly coronary microcirculation disorder patients after acute myocardial infarction(AMI).Methods One hundred and fifteen AMI patients with coronary microcirculation disorder who underwent myocardial contrast echocardiography in our hospital from June 2016 to September 2021 were divided into≥75 years old group(n=20)and<75 years old group or control group(n=95).Their baseline data,left ventricular end-diastolis dimension(LVEDD),LVEF,global longitudinal strain(GLS),wall motion score index(WMSI),regional wall motion abnormality(RWMA)and myocardium perfusion index(MPI)were recorded.The patients were followed up for 8(3,13)months,during which the major adverse cardiovascular events(MACE)were recorded.Results The ratio of female patients and incidence of NSTEMI were significantly higher in≥75 years old group than in control group(50.0%vs 18.9%,P=0.003;40.0%vs 15.8%,P=0.014).Significant difference was detected in Killip grading between the two groups(P=0.014).No significant difference was detected in LVEDD,LVEF,GLS,RWMA,WMSI and MPI between the two groups(P>0.05).The readmission rate and incidence of heart failure and total MACE were significantly higher in≥75 years old group than in control group after adjustment of sex,Killip grading and NSTEMI(OR=4.017,95%CI:1.255-12.861,P=0.019;OR=4.179,95%CI:1.296-13.470,P=0.017;OR=2.594,95%CI:1.056-6.370,P=0.038).Conclusion The left ventricular sys-tolic function and wall motion are impaired and the the risk of long-term MACE is significantly higher in≥75 years old coronary microcirculation disorder patients after AMI.

关 键 词：心肌梗死 微循环 冠状动脉疾病 心力衰竭 

分 类 号：R542.22[医药卫生—心血管疾病]