{"title":"非阻塞性冠状动脉疾病合并急性心肌梗死的患者比阻塞性冠状动脉疾病的患者预后更好","authors":"Yasser Yazied Abdelmonem, Adel Abdelgawad Bakr, Hossam Ghanem El-Hossary, Mohammed Mahmoud Abdel Ghany","doi":"10.1016/j.ehj.2017.03.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.</p></div><div><h3>Aim</h3><p>The present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.</p></div><div><h3>Methods</h3><p>This prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions >70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.</p></div><div><h3>Results</h3><p>Patients with insignificant CAD were significantly younger (61<!--> <!-->vs. 67<!--> <!-->years, p<!--> <!--><<!--> <!-->0.001), more likely to be females<!--> <!-->(41% vs. 23%, p<!--> <!-->=<!--> <!-->0.006), less likely to smoke (p<!--> <!-->=<!--> <!-->0.006), less likely to have diabetes mellitus (p<!--> <!--><<!--> <!-->0.001), and less likely to have history of CAD (p<!--> <!-->=<!--> <!-->0.042) or prior PCI (p<!--> <!-->=<!--> <!-->0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p<!--> <!--><<!--> <!-->0.001), less likely to have heart failure at presentation (9% vs 30%, p<!--> <!--><<!--> <!-->0.001),<!--> <!-->less likely to have<!--> <!-->ischemic ST-segment changes on presentation (10% vs 46%, p<!--> <!--><<!--> <!-->0.001), lower peak troponin (p<!--> <!--><<!--> <!-->0.001) and CK-MB levels (p<!--> <!--><<!--> <!-->0.001), with lower LDL-C (p<!--> <!-->=<!--> <!-->0.006), and higher HDL-C level (p<!--> <!-->=<!--> <!-->0.020). They were less likely to be treated with b-blockers (p<!--> <!-->=<!--> <!-->0.002), ACEI/ARBS (p<!--> <!-->=<!--> <!-->0.007), and higher rates of calcium channel blocker therapy (p<!--> <!--><<!--> <!-->0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p<!--> <!-->=<!--> <!-->0.009), need for revascularization (p<!--> <!-->=<!--> <!-->0.035), recurrent chest pain (p<!--> <!-->=<!--> <!-->0.009), and cardiogenic shock (p<!--> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.</p></div>","PeriodicalId":44962,"journal":{"name":"Egyptian Heart Journal","volume":"69 3","pages":"Pages 191-199"},"PeriodicalIF":1.4000,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.001","citationCount":"2","resultStr":"{\"title\":\"Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease\",\"authors\":\"Yasser Yazied Abdelmonem, Adel Abdelgawad Bakr, Hossam Ghanem El-Hossary, Mohammed Mahmoud Abdel Ghany\",\"doi\":\"10.1016/j.ehj.2017.03.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.</p></div><div><h3>Aim</h3><p>The present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.</p></div><div><h3>Methods</h3><p>This prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions >70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.</p></div><div><h3>Results</h3><p>Patients with insignificant CAD were significantly younger (61<!--> <!-->vs. 67<!--> <!-->years, p<!--> <!--><<!--> <!-->0.001), more likely to be females<!--> <!-->(41% vs. 23%, p<!--> <!-->=<!--> <!-->0.006), less likely to smoke (p<!--> <!-->=<!--> <!-->0.006), less likely to have diabetes mellitus (p<!--> <!--><<!--> <!-->0.001), and less likely to have history of CAD (p<!--> <!-->=<!--> <!-->0.042) or prior PCI (p<!--> <!-->=<!--> <!-->0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p<!--> <!--><<!--> <!-->0.001), less likely to have heart failure at presentation (9% vs 30%, p<!--> <!--><<!--> <!-->0.001),<!--> <!-->less likely to have<!--> <!-->ischemic ST-segment changes on presentation (10% vs 46%, p<!--> <!--><<!--> <!-->0.001), lower peak troponin (p<!--> <!--><<!--> <!-->0.001) and CK-MB levels (p<!--> <!--><<!--> <!-->0.001), with lower LDL-C (p<!--> <!-->=<!--> <!-->0.006), and higher HDL-C level (p<!--> <!-->=<!--> <!-->0.020). They were less likely to be treated with b-blockers (p<!--> <!-->=<!--> <!-->0.002), ACEI/ARBS (p<!--> <!-->=<!--> <!-->0.007), and higher rates of calcium channel blocker therapy (p<!--> <!--><<!--> <!-->0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p<!--> <!-->=<!--> <!-->0.009), need for revascularization (p<!--> <!-->=<!--> <!-->0.035), recurrent chest pain (p<!--> <!-->=<!--> <!-->0.009), and cardiogenic shock (p<!--> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.</p></div>\",\"PeriodicalId\":44962,\"journal\":{\"name\":\"Egyptian Heart Journal\",\"volume\":\"69 3\",\"pages\":\"Pages 191-199\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2017-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1016/j.ehj.2017.03.001\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Egyptian Heart Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1110260817300108\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Egyptian Heart Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1110260817300108","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 2
摘要
背景急性心肌梗死(AMI)合并轻微冠状动脉狭窄患者的特征尚不清楚。目的探讨急性心肌梗死(AMI)冠脉狭窄不明显患者与冠脉狭窄明显患者的临床特点、住院情况及3个月预后。方法本前瞻性观察性研究纳入200例AMI患者。第一组(100例)包括不明显的CAD患者(所有病变&狭窄50%)。第二组(100例)包括一个或多个病变>70%狭窄的患者。既往冠脉搭桥患者排除在外。有明显冠心病的患者全血管重建术成功。结果冠心病不显著的患者明显年轻化(61岁vs. 67岁，p <0.001)，女性的可能性更大(41%对23%，p = 0.006)，吸烟的可能性更小(p = 0.006)，患糖尿病的可能性更小(p <0.001)，有CAD病史(p = 0.042)或PCI病史(p = 0.037)的可能性较小。他们也不太可能在就诊时出现典型的心绞痛(61% vs 91%， p <0.001)，就诊时发生心力衰竭的可能性较低(9% vs 30%， p <0.001)，出现缺血性st段改变的可能性较小(10% vs 46%， p <0.001)，肌钙蛋白峰值较低(p <0.001)和CK-MB水平(p <0.001)， LDL-C较低(p = 0.006)， HDL-C较高(p = 0.020)。他们接受b受体阻滞剂(p = 0.002)、ACEI/ARBS (p = 0.007)治疗的可能性较小，而接受钙通道阻滞剂治疗的比例较高(p <0.001)。在随访中，他们的主要不良临床事件发生率较低(ACS再入院(p = 0.009)，需要血运重建(p = 0.035)，复发性胸痛(p = 0.009)和心源性休克(p = 0.029)。结论AMI合并不明显冠心病患者的临床表现和转归与明显病变患者不同。
Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease
Background
The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.
Aim
The present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.
Methods
This prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions >70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.
Results
Patients with insignificant CAD were significantly younger (61 vs. 67 years, p < 0.001), more likely to be females (41% vs. 23%, p = 0.006), less likely to smoke (p = 0.006), less likely to have diabetes mellitus (p < 0.001), and less likely to have history of CAD (p = 0.042) or prior PCI (p = 0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p < 0.001), less likely to have heart failure at presentation (9% vs 30%, p < 0.001), less likely to have ischemic ST-segment changes on presentation (10% vs 46%, p < 0.001), lower peak troponin (p < 0.001) and CK-MB levels (p < 0.001), with lower LDL-C (p = 0.006), and higher HDL-C level (p = 0.020). They were less likely to be treated with b-blockers (p = 0.002), ACEI/ARBS (p = 0.007), and higher rates of calcium channel blocker therapy (p < 0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p = 0.009), need for revascularization (p = 0.035), recurrent chest pain (p = 0.009), and cardiogenic shock (p = 0.029).
Conclusion
Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.
期刊介绍：
The Egyptian Heart Journal is the official journal of the Egyptian Society of Cardiology. It is an international journal that publishes peer-reviewed articles on all aspects of cardiovascular disease, including original clinical studies and translational investigations. The journal publishes research, review articles, case reports and commentary articles, as well as editorials interpreting and commenting on the research presented. In addition, it provides a forum for the exchange of information on all aspects of cardiovascular medicine, including educational issues.
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