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冠状动脉非阻塞性心肌梗死患者的临床特点和预后分析

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目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特点和随访1年内发生主要不良心血管事件(MACE)的危险因素.方法:选择2018年9月至2021年9月我院心血管内科符合急性心肌梗死诊断并且行冠状动脉造影的1 866例患者.根据冠状动脉造影的结果将患者分为MINOCA组及冠状动脉阻塞性心肌梗死(MI-CAD)组,比较2组患者的临床特点和随访1年MACE的发生情况.根据是否发生MACE,再将MINOCA组的患者分为MACE组和非MACE组.采用二元Logistic回归分析探讨MINOCA患者发生MACE的危险因素.结果:MINOCA组患者的年龄低于MI-CAD组,女性患者多,合并心血管疾病的危险因素低于MI-CAD组,实验室部分指标低于MI-CAD组;心脏彩超左心室射血分数(LVEF)高于MI-CAD组,左心室舒张末期内径(LVEDD)低于MI-CAD组,室壁运动异常和心功能分级高患者的比例低于MI-CAD组,差异有统计学意义(P<0.05).随访1年结果显示MINOCA组和MI-CAD组MACE的发生率比较差异无统计学意义(P>0.05).二元Logistic回归分析结果显示,吸烟(OR=13.095,95%CI:1.799~7.398)、LVEF低(OR= 0.036,95%CI:0.012~0.679)是MIONCA患者发生MACE的独立危险因素.结论:MINOCA女性患者较多,年龄偏低,合并心血管危险因素少,但MACE的发生并不比MI-CAD患者少.吸烟、LVEF低是MINOCA患者发生MACE的独立危险因素.
Clinical characteristics and prognosis of patients with myocardial infarction with non-obstructive coronary arteries
Objective:To investigate the clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries(MINOCA)and the risk factors of major adverse cardiovascular events(MACE)within 1 year of follow-up.Methods:A total of 1 866 patients who met the diagnosis of acute myocardial infarction and underwent coronary angiography in the Department of Cardiovascular Medicine of our hospital from Sep 2018 to Sep 2021 were selected.According to the results of coronary angiography,the patients were divided into MINOCA group and myocardial infarction with obstructive coronary artery disease(MI-CAD)group.The clinical characteristics and the occurrence of MACE in the two groups were compared.According to the occurrence of MACE,patients in MINOCA group were divided into MACE group and non-MACE group.Binary logistic regression analysis was used to explore the risk factors for MACE in MINOCA patients.Results:The age of patients in MINOCA group was lower than that in MI-CAD group,and more patients were female(P<0.05).The risk factors of cardiovascular diseases in MINOCA group were less than those in MI-CAD group(P<0.05).Some indexes of laboratory were lower than those in MI-CAD group(P<0.05).Left ventricular ejection fraction(LVEF)were higher than that in MI-CAD group(P<0.05).Left ventricular end-diastolic inner diameter(LVEDD)was lower than that in MI-CAD group,and the proportion of patients with abnormal ventricular wall motion and high cardiac function grade was lower than that in MI-CAD group,and the difference was statistically significant(P<0.05).The 1-year follow-up showed no significant difference in the incidence of MACE between the two groups(P=0.115).Binary logistic regression analysis showed that smoking(OR=13.095,95%CI:1.799-7.398)and low LVEF(OR=0.036,95%CI:0.012-0.679)were independent risk factors for MACE in MIONCA patients.Conclusions:MINOCA patients are more common in women,with lower age and fewer cardiovascular risk factors,but the incidence of MACE is not less than that of MI-CAD patients.Smoking and low LVEF are independent risk factors for MACE in MINOCA patients.

myocardial infarction with non-obstructive coronary arteriesclinical characteristicsmajor adverse cardiovascu-lar eventsprognosis

范蒙蒙、张学平、刘志强

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新乡市中心医院心血管内科四,新乡医学院第四临床学院,河南 新乡 453000

冠状动脉非阻塞性心肌梗死 临床特点 主要不良心血管事件 预后

2024

沈阳医学院学报
沈阳医学院

沈阳医学院学报

影响因子:0.591
ISSN:1008-2344
年,卷(期):2024.26(2)
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