冠状动脉非阻塞性心肌梗死的临床特征分析

摘要
图/表
参考文献(20)
相关文章 (13)

全文: PDF (477 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的分析冠状动脉非阻塞性心肌梗死（MINOCA）及冠状动脉阻塞性心肌梗死（MIOCA）患者的临床特征。方法随机入选2017年1月～2019年1月于武汉大学人民医院住院的急性心肌梗死患者445例，根据冠脉造影结果分为MINOCA组（89例）和MIOCA组（356例），比较两组一般资料、主诉症状特点、心电图表现等。结果两组年龄、性别、冠心病史、肌钙蛋白I、肌酸激酶同工酶、肌红蛋白、氨基末端脑钠肽前体、左室射血分数、高密度脂蛋白胆固醇比较，差异有统计学意义（P ＜ 0.05）。两组体重指数、高血压史、糖尿病史、高脂血症史、吸烟史、家族史、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、游离脂肪酸、空腹血糖、肌酐比较，差异无统计学意义（P ＞ 0.05）。MINOCA组胸痛伴放射痛发生率低于MIOCA组，含服硝酸甘油有效率高于MIOCA组，差异有统计学意义（P ＜ 0.05）。两组胸闷、胸痛、症状出现时间<3 d比较，差异无统计学意义（P ＞ 0.05）。MINOCA组正常、T波改变发生率低于MIOCA组，ST段抬高、病理性Q波形成、完全性左束支传导阻滞发生率高于MIOCA组，差异有统计学意义（P ＜ 0.05）。两组ST段压低≥0.05 mV、室性早搏、短阵室速、室性心动过速、室颤发生率比较，差异无统计学意义（P > 0.05）。结论临床上，MINOCA心肌酶指标、心功能、胸痛症状、心电图表现均较MIOCA轻，且两者在高危因素上除年龄外，其余并无明显差异。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	罗群华黎明江王鑫杨政

关键词 ：冠状动脉非阻塞性心肌梗死, 临床特征, 胸痛

Abstract：Objective To analyze the clinical features of myocardial infarction with non-obstructive coronary artery (MINOCA) and myocardial infarction with obstructive coronary artery (MIOCA). Methods A total of 445 patients with acute myocardial infarction admitted to Renmin Hospital of Wuhan University from January 2017 to January 2019 were randomly selected. According to the results of coronary angiography, they were divided into MINOCA group (89 cases) and MIOCA group (356 cases). The general data, the characteristics of the main complaints, and the electrocardiogram were compared between two groups. Results There were significant differences in age, sex, history of coronary heart disease, troponin I, creatine kinase isoenzyme, myoglobin, pro amino terminal brain natriuretic peptide, left ventricular ejection fraction and high-density lipoprotein cholesterol between two groups (P ＜ 0.05). There was no significant difference in BMI, hypertension, diabetes, hyperlipidemia, smoking, family history, triacylglycerol, total cholesterol, LDL cholesterol, free fatty acids, fasting blood glucose and creatinine between two groups (P ＞ 0.05). The incidence of chest pain and radiation pain in MINOCA group was lower than that in MIOCA group, and the effective rate of nitroglycerin in MINOCA group was higher than that in MIOCA group, the differences were statistically significant (P ＜ 0.05). There was no significant difference between two groups in occurrence time of chest distress, chest pain and symptoms < 3 d (P ＞ 0.05). The incidence of normal and T wave changes in MINOCA group was lower than that in MIOCA group, and the incidence of ST segment elevation, pathological Q wave formation and complete left bundle branch block in MINOCA group was higher than that in MIOCA group, the differences were statistically significant (P ＜ 0.05). There was no significant difference between two groups in the incidence of ST segment depression ≥ 0.05 mV, ventricular premature beat, short array ventricular tachycardia, ventricular tachycardia and ventricular fibrillation (P ＞ 0.05). Conclusion Clinically, MINOCA myocardial enzyme index, cardiac function, chest pain symptoms, and electrocardiogram performance are lighter than MIOCA, and there is no significant difference between two groups in terms of high risk factors except age.

Key words： Myocardial infarction with non-obstructive coronary artery Clinical features Chest pain

基金资助:国家自然科学基金资助项目（81500255）；
国家自然科学基金资助项目（81800216）。

通讯作者: 黎明江（1967.8-），男，博士，主任医师，教授；研究方向：冠心病心脏纤维化。

作者简介: 罗群华（1992.8-），女，武汉大学医学院2017级心内科专业在读硕士研究生；研究方向：冠心病与心脏纤维化。

引用本文:

罗群华黎明江王鑫杨政. 冠状动脉非阻塞性心肌梗死的临床特征分析[J]. 中国医药导报, 2020, 17(5): 59-62.
LUO Qunhua LI Mingjiang WANG Xin YANG Zheng. Analysis of clinical features in patients with myocardial infarction with non-obstructive coronary artery. 中国医药导报, 2020, 17(5): 59-62.

链接本文:

http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I5/59

[1] Bainey KR，Welsh RC，Alemayehu W，et al. Population-level incidence and outcomes of myocardial infarction with non-obstructive coronary arteries （MINOCA）：insights from the alberta contemporary acute coronary syndrome patients invasive treatment strategies （COAPT） study [J]. Int J Cardiol，2018，264：12-17.
[2] Agewall S，Beltrame JF，Reynolds HR，et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries [J]. Eur Heart J，2017，38（3）：143-153.
[3] Niccoli G，Scalone G，Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis：mechanisms and management [J]. Eur Heart J，2015，36（8）：475-481.
[4] Mehta PK，Beltrame JF. Myocardial infarction with non-obstructive coronary arteries：a humbling diagnosis in 2018 [J]. Heart，2019，105（7）：506-507.
[5] Williams M，Barr PR，Lee M，et al. Outcome after myocardial infarction without obstructive coronary artery disease [J]. Heart，2019，105（7）：524-530.
[6] Thygesen K，Alpert JS，Jaffe AS，et al. Fourth universal definition of myocardial infarction （2018） [J]. Circulation，2018，138（20）：e618-e651.
[7] Tamis-Holland JE，Jneid H，Reynolds HR，et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease：a scientific statement from the American Heart Association [J]. Circulation，2019，139（18）：e891-e908.
[8] Montone RA，Niccoli G，Russo M，et al. Clinical，angiographic and echocardiographic correlates of epicardial and microvascular spasm in patients with myocardial ischaemia and non-obstructive coronary arteries [J]. Clin Res Cardiol，2019. [Epub ahead of print]
[9] Pasupathy S，Air T，Dreyer RP，et al. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries [J]. Circulation，2015，131（10）：861-870.
[10] Safdar B，Spatz ES，Dreyer RP，et al. Presentation，clinical profile，and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries （MINOCA）：results from the VIRGO study [J]. J Am Heart Assoc，2018，7（13）：e009174.
[11] Barr PR，Harrison W，Smyth D，et al. Myocardial infarction without obstructive coronary artery disease is not a benign condition （ANZACS-QI 10） [J]. Heart Lung Circ，2018，27（2）：165-174.
[12] Smilowitz NR，Mahajan AM，Roe MT，et al. Mortality of myocardial infarction by sex，age，and obstructive coronary artery disease status in the ACTION registry-GWTG （acute coronary treatment and intervention outcomes network registry-get with the guidelines） [J]. Circ Cardiovasc Qual Outcomes，2017，10（12）：e3443.
[13] Daniel M，Agewall S，Caidahl K，et al. Effect of myocardial infarction with nonobstructive coronary arteries on physical capacity and quality-of-life [J]. Am J Cardiol，2017，120（3）：341-346.
[14] Dreyer RP，Tavella R，Curtis JP，et al. Myocardial infarction with non-obstructive coronary arteries as compared with myocardial infarction and obstructive coronary disease：outcomes in a medicare population [J]. Eur Heart J，2019. [Epub ahead of print]
[15] Raparelli V，Elharram M，Shimony A，et al. Myocardial infarction with no obstructive coronary artery disease：angiographic and clinical insights in patients with premature presentation [J]. Can J Cardiol，2018，34（4）：468-476.
[16] Montone RA，Niccoli G，Fracassi F，et al. Patients with acute myocardial infarction and non-obstructive coronary arteries：safety and prognostic relevance of invasive coronary provocative tests [J]. Eur Heart J，2018，39（2）：91-98.
[17] Hausvater A，Pasupathy S，Tornvall P，et al. ST-segment elevation and cardiac magnetic resonance imaging findings in myocardial infarction with non-obstructive coronary arteries [J]. Int J Cardiol，2019，287：128-131.
[18] 苏斌杰，郭长峰，李海玲，等.冠状动脉非阻塞性心肌梗死患者的临床特征、治疗现状及院内预后分析[J].国际心血管病杂志，2019，46（1）：47-51.
[19] Abdu FA，Liu L，Mohammed AQ，et al. Myocardial infarction with non-obstructive coronary arteries （MINOCA） in Chinese patients：clinical features，treatment and 1year follow-up [J]. Int J Cardiol，2019，287：27-31.
[20] Nordenskjold AM，Baron T，Eggers KM，et al. Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery （MINOCA） disease [J]. Int J Cardiol，2018，261：18-23.