冠状动脉非阻塞性心肌梗死的临床特征及院内死亡结局分析  

Analysis of clinical features and the outcome of in-hospital mortality of myocardial infarction with non-obstructive coronary arteries

作　　者：张颂 张晓[1] 吴硕[1] 张涛 姬红梅 张琪[1] 高洁[1] 潘畅[1] 庞佼佼 徐峰[1] 王甲莉[1] 陈玉国[1] Zhang Song;Zhang Xiao;Wu Shuo;Zhang Tao;Ji Hongmei;Zhang Qi;Gao Jie;Pan Chang;Pang Jiaojiao;Xu Feng;Wang Jiali;Chen Yuguo(Department of Emergency Medicine and Chest Pain Center,Qilu Hospital of Shandong University,Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine,Institute of Emergency and Critical Care Medicine of Shandong University,Key Laboratory of Emergency and Critical Care Medicine of Shandong Province Health System,Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Higher Education of Shandong Province,Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine,Jinan 250012,China;Department of Biostatistics,School of Public Health,Cheeloo College of Medicine,Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院急诊科胸痛中心,山东省急危重症临床医学研究中心,山东大学急危重症医学研究所,山东省卫生系统急危重症医学重点实验室,山东省高等学校心肺脑复苏研究重点实验室,山东省急危重症防治工程实验室,济南250012 [2]山东大学齐鲁医学院公共卫生学院生物统计学教研室,济南250012

出　　处：《中华心血管病杂志》2022年第9期873-880,共8页Chinese Journal of Cardiology

基　　金：国家重点研发计划(2020YFC1512700,2020YFC1512705,2020YFC1512703);国家科技基础资源调查专项(2018FY100600,2018FY100602);山东省重点研发计划(2021ZLGX02,2021SFGC0503);泰山学者攀登计划专家建设工程专项经费(tspd20181220);泰山学者青年专家建设工程专项经费(tsqn20161065,tsqn201812129);国家万人计划青年拔尖人才项目;齐鲁青年学者项目。

摘　　要：目的分析冠状动脉非阻塞性心肌梗死(MINOCA)患者与冠状动脉阻塞性心肌梗死(MI-CAD)患者临床特征及院内死亡结局的差异。方法本研究为回顾性成组病例分析,选取山东大学齐鲁医院2017年1月至2021年5月收治的入院行冠状动脉造影的急性心肌梗死患者,依据冠状动脉狭窄程度<50%或≥50%,分为MINOCA组和MI-CAD组。收集并比较两组患者的基线临床特征和住院期间心电图、心肌桥、住院天数、出院带药及院内结局相关指标,采用单因素和多因素logistic回归分析,筛选MINOCA的相关因素并预测急性心肌梗死患者院内死亡结局的因素。结果共纳入急性心肌梗死患者3048例,年龄62(54,69)岁,女性741例(24.3%),其中MINOCA组165例(5.4%),MI-CAD组2883例(94.6%)。与MI-CAD患者相比,MINOCA患者较年轻,女性占比较高,非ST段抬高型心肌梗死发生率较高,有吸烟史和糖尿病史、冠心病史、心肌梗死史的比例较低,炎性指标包括中性粒细胞计数、单核细胞计数、中性粒细胞计数/淋巴细胞计数(NLR)、单核细胞计数/高密度脂蛋白(MHR)较低,肌酐、N末端B型利钠肽前体、肌酸激酶同工酶、超敏肌钙蛋白I、纤维蛋白原、空腹血糖水平较低,高密度脂蛋白水平较高;心肌桥、心律失常、心动过速、心房颤动的发生率较高;钙离子拮抗剂及非维生素K拮抗剂口服抗凝药应用率较高(P均<0.05);住院天数及院内死亡比较差异无统计意义(P均>0.05)。多因素logistic回归分析显示低龄、女性、无吸烟史或冠心病史、MHR较低更易发生MINOCA(P均<0.05);MINOCA与发生院内死亡无关(P>0.05),冠心病史、慢性肾衰竭病史、空腹血糖、NLR、D-二聚体较高的急性心肌梗死患者更易发生院内死亡(P均<0.05)。结论与MI-CAD相比,MINOCA患者呈现低龄、女性、无吸烟史或冠心病史、MHR较低的特征,MINOCA常伴发心肌桥及心房颤动。MINCOA患者院内死亡的发生率与MI-CAD患�Objective To compare the clinical features and the outcome of in-hospital mortality between patients with myocardial infarction with non-obstructive coronary arteries(MINOCA)and myocardial infarction with obstructive coronary artery disease(MI-CAD).Methods This is a retrospective study.The clinical data of acute myocardial infarction(AMI)patients admitted to Qilu Hospital of Shandong University from January 2017 to May 2021,who underwent coronary angiography,were collected.Patients were divided into MINOCA group and MI-CAD group according to the degree of coronary stenosis(<50%or≥50%).Baseline clinical characteristics,electrocardiograph during hospitalization,myocardial bridge,length of stay in hospital,discharge medication and the outcome of in-hospital mortality were collected and compared between the two groups.Univariate and multivariate logistic regression analysis was used to screen the related factors of MINOCA and the factors predicting the nosocomial death outcome of patients with AMI.Results A total of 3048 AMI patients were enrolled,age was 62(54,69)years,741(24.3%)patients were women including 165 patients(5.4%)in the MINOCA group and 2883 patients(94.6%)in the MI-CAD group.Compared with MI-CAD patients,MINOCA patients were younger,had a higher proportion of females and a higher incidence of NSTEMI,and had a lower history of smoking,diabetes,coronary heart disease and myocardial infarction.Baseline inflammatory markers such as neutrophil count,monocyte count,neutrophil count/lymphocyte count(NLR),and monocyte count/high-density lipoprotein count(MHR)were lower,creatinine,N-terminal pro-brain B-type Natriuretic peptides(NT-proBNP),creatine kinase-MB,hypersensitive troponin I,fibrinogen,baseline blood glucose levels were lower,high-density lipoprotein cholesterol was higher,and the incidence of myocardial bridge,arrhythmia,tachycardia and atrial fibrillation was higher(P<0.05).The application rates of calcium antagonists and non-vitamin K antagonists oral anticoagulants were higher in MINOCA group(P<0

关 键 词：心肌梗死 非阻塞性冠状动脉 炎性指标 心肌桥 院内死亡 

分 类 号：R542.22[医药卫生—心血管疾病]