急性心肌梗死合并癌症患者的临床特征及冠状动脉病变特点  

Clinical and Coronary Angiographic Characteristics in Acute Myocardial Infarction Patients with Cancer

作　　者：王可[1] 施展 WANG Ke;SHI Zhan(Department of Cardiology,The First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院心血管内科,合肥230001

出　　处：《岭南心血管病杂志》2023年第5期475-480,492,共7页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划(项目编号:2021YFA0804904)。

摘　　要：目的探讨急性心肌梗死(acute myocardial infarction,AMI)合并癌症患者的临床特征及冠状动脉病变特点。方法回顾性连续纳入2015年5月至2021年9月于中国科学技术大学附属第一医院心内科住院并诊断为AMI患者。将接受冠状动脉造影的癌症与非癌症患者进行1:2倾向性评分匹配(propensity score match,PSM),最终纳入89例癌症患者和178例非癌症患者。结果本研究共纳入AMI患者2225例,其中癌症患者107例(4.8%)。与非癌症患者相比,癌症患者年龄更大,男性占比更多,接受冠状动脉造影及经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗比例更低,院内病死率更高,差异有统计学意义(P<0.05)。倾向性评分匹配结果显示接受PCI治疗的癌症与非癌症患者院内病死率、急性脑卒中及大出血发生率比较,差异无统计学意义(P>0.05);但癌症患者N末端脑钠肽前体及肌钙蛋白Ⅰ浓度更高,左心室射血分数更低,差异有统计学意义(P<0.05)。此外,癌症患者发生冠状动脉完全闭塞比例更高,术中更多使用抽吸导管及替罗非班,合并高血栓负荷病变比例更高,差异均有统计学意义(P<0.05)。经PCI治疗后,两组患者冠状动脉“罪犯”血管恢复冠状动脉血流心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)血流3级比例类似,差异无统计学意义(P>0.05)。结论癌症患者发生心肌梗死后接受冠状动脉侵入性治疗的比例更低,左心室收缩功能更差,但住院期间PCI治疗的有效性及安全性与非癌症患者无显著统计学差异。Objectives To investigate the clinical and coronary angiographic characteristics in acute myocardial infarction(AMI)patients with cancer.Methods Consecutive patients admitted to The First Affiliated Hospital of University of Science and Technology of China between May 2015 and September 2021 with AMI were retrospectively analysed.Propensity score matching in 1∶2 ratio was performed,which yield 89 patient with cancer and 178 patients without cancer.All the patents underwent coronary angiography(CAG).Results A total of 2225 patients were enrolled,of whom 107(4.8%)patients presented with cancer.Compared with patients without cancer,patients with cancer were older and more often male,were less likely to undergo CAG and percutaneous coronary intervention(PCI),and had higher in-hospital mortality(all P<0.05).Propensity score matching demonstrated the rate of in-hospital mortality,acute stroke and major bleeding were similar between the two groups(all P>0.05).Patients with cancer,however,had significantly higher concentrations of N-terminal brain natriuretic peptide(NT-proBNP)and cardiac troponin I,and had significantly lower left ventricular ejection fraction(all P<0.05).Furthermore,the rates of total occlusion of coronary artery and high-burden thrombus formation were significantly increased in patients with cancer.There was a more frequent usage of thrombus aspiration and tirofiban in patients with cancer(all P<0.05).Following PCI,the rate of thrombolysis in myocardial infarction(TIMI)flow grade 3 of the culprit artery was not significantly different between the two groups.Conclusions Cancer patents with AMI were less likely to undergo invasive coronary treatment,and had a significantly higher rate of left-ventricular systolic dysfunction.However,the efficacy and safety of PCI during hospitalization was similar between the two groups.

关 键 词：心肌梗死 癌症 经皮冠状动脉介入治疗 倾向性评分匹配 

分 类 号：R542.22[医药卫生—心血管疾病]