冠状动脉非阻塞性心肌梗死患者的患病率、临床特征、治疗和预后。

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2024-07-31 DOI:10.18087/cardio.2024.7.n2526

T H Hoang, V V Maiskov, I A Merai, Zh D Kobalava

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引用次数: 0

摘要

目的：与冠状动脉阻塞性心肌梗死（MIOCA）患者相比，研究冠状动脉非阻塞性心肌梗死（MINOCA）患者的临床和人口统计学特征、治疗方案和临床结果：这项单中心前瞻性观察研究共纳入了 712 名连续确诊为急性心肌梗死（MI）的患者，这些患者均常规接受了直接冠状动脉造影术。根据是否存在狭窄性冠状动脉粥样硬化，患者被分为两组：MIOCA组（冠状动脉狭窄≥50%）和MINOCA组（冠状动脉狭窄<50%，无其他原因）。临床结果包括院内死亡率、长期总死亡率和心血管再住院率。中位随访时间为 1.5 年：73例（10.3%）患者被诊断为MINOCA，其中37例（50%）为女性。MINOCA 患者的中位年龄为 61 岁，MIOCA 组患者的中位年龄为 65 岁。MINOCA 和 MIOCA 患者的心血管风险因素无明显差异。在 53.4% 的病例中，MINOCA 的病因是心肌供氧和需氧之间的差异，而在 35.6% 的病例中，病因是高血压危象和肺水肿。与 MINOCA 相关的因素包括年龄小于 58 岁、女性、无 ST 段抬高、无局部收缩力受损区域、存在主动脉瓣狭窄和支气管肺部感染。MINOCA患者接受乙酰水杨酸、P2Y12抑制剂、双重抗血小板疗法、β-受体阻滞剂和他汀类药物治疗的可能性较低（p<0.05）。87.5%的患者（n=623）获得了长期预后数据。在院内死亡率（1.5% 对 6.2%；P=0.161）和长期总死亡率（6.1% 对 14.7%；P=0.059）方面，MIOCA 患者的预后相当。MINOCA组的心血管疾病再住院率更高（33.3% vs. 21.5%；P=0.042）：结论：在我们的研究中，急性心肌梗死患者中MINOCA的发病率为10.3%。MINOCA患者与MIOCA患者具有相似的公认心血管风险因素。MINOCA患者的院内死亡率和长期死亡率与MIOCA患者相当，但需要心血管再住院的情况更多。

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Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries.

Aim: To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA).

Material and methods: This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years.

Results: MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042).

Conclusion: The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.