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冠状动脉非阻塞性心肌梗死患者的1年预后及预后影响因素分析 预览

Results of one-year follow-up and influencing factors of outcomes in patients with myocardial infarction with non-obstructive coronary arteries
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摘要 目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的1年预后及预后影响因素。 方法:收集2014年4月至2017年11月符合急性心肌梗死(AMI)诊断且冠状动脉造影检查显示冠状动脉非阻塞(狭窄<50%)的MINOCA患者。分析患者的临床特征、治疗策略、随访1年主要不良心血管事件(MACE)的发生率和预后影响因素。 结果:2 660例AMI患者中159例诊断为MINOCA,患病率为6.0%。MINOCA平均年龄为(62.7±12.9)岁,女性74例(46.5%),非ST段抬高型心肌梗死(NSTEMI)多于ST段抬高型心肌梗死(STEMI)(57.9%对42.1%,P=0.007),冠状动脉无狭窄者82例(51.6%),存在狭窄病变(<50%)者77例(48.4%)。MINOCA患者入院期间使用传统二级预防治疗药物的比例偏低,随访1年时,除钙离子拮抗剂(CCB)类药物,其他药物使用比例均明显下降(P均<0.05)。1年随访中MINOCA患者发生MACE 27例(19.4%),其中心源性死亡5例(3.6%),心力衰竭3例(2.2%),因心血管事件再住院19例(13.7%),无非致命性再发心肌梗死发生。Logistic回归分析显示,MACE的独立预测因子是年龄≥60岁、低总胆固醇(TC)水平和低左室射血分数(LVEF)。 结论:中国MINOCA患者1年预后情况不乐观,年龄≥60岁、低TC和低LVEF是MACE的独立危险因素。 Objective:To investigate the results of one-year follow-up and influencing factors of outcomes in patients with myocardial infarction with non-obstructive coronary arteries(MINOCA). Methods:From April 2014 to November 2017,patients diagnosed as acute myocardial infarction(AMI) with coronary angiography examination evidenced stenosis<50% were enrolled.Clinical features, medical management as well as incidence and influencing factors of major adverse cardiovascular events (MACE)within one-year follow-up in all participants were assessed. Results:Among2 660 patients with AMI,159 patients(6.0%)were diagnosed as MINOCA,with an average age of(62.7±12.9)years,of which 74 were females (46.5%).The prevalence of non-ST-segment elevation myocardial infarction (NSTEMI)was higher than of ST-segment elevation myocardial infarction(STEMI)(57.9% vs.42.1%, P=0.007)in patients with MINOCA.None coronary artery stenosis was observed in 82 cases(51.6%), stenosis<50%in77 cases(48.4%).The proportion of patients using secondary preventive drugs in hospital was low.Except for calcium channel blockers(CCB),the use of these drugs declined within one year follow-up (all P<0.05).A total of 27 patients(19.4%)had MACE:five patients(3.6%)had cardiovascular death;three(2.2%)suffered heart failure and 19(13.7%)developed cardiovascular-related rehospitalization.There was no nonfatal AMI occurred.The logistic regression model showed that age≥60 years,lower level of total cholesterol(TC)and reduced left ventricular ejection fraction(LVEF)were significant predictors of MACE. Conclusions:The one-year prognosis of MINOCA patients is not optimistic.Age≥60 years,lower level of TC and LVEF are independent risk factors for MACE in patients with MINOCA.
作者 刘露 弗瓦德 印国庆 徐斌 骆艳茹 徐思玲 吕贤 车文良 LIU Lu;FUAD A.Abdu;YIN Guoqing;XU Bin;LUO Yanru;XU Siling;LV Xian;CHE Wenliang(Department of Cardiology,Clinical Medical College,Shanghai Tenth People′s Hospital of Nanjing Medical University,Nanjing 210029;Department of Cardiology,Shanghai Tenth People′s Hospital,Tongji University School of Medicine,Shanghai 200072,China)
出处 《国际心血管病杂志》 2019年第4期239-244,共6页 International Journal of Cardiovascular Disease
基金 国家自然科学基金(81570436) 上海市崇明区“可持续发展科技创新行动计划”项目(CKY2018-18) 上海市卫计委面上项目(201640053).
关键词 冠状动脉粥样硬化性心脏病 急性冠脉综合征 心肌梗死 冠状动脉造影术 危险因素 随访研究 预后 Coronary artery disease Acute coronary syndrome Myocardial infarction Coronary angiography Risk factors Follow-up studies Prognosis
作者简介 通信作者:车文良,Email:chewenliang@tongji.edu.cn.
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