在 HORIZONS-AMI 试验中，心尖球囊综合征（心尖气球样变/应激性心肌病）患者的发生率和血管造影特征：一项来自多中心、国际性 ST 段抬高型心肌梗死研究的分析。
Incidence and angiographic characteristics of patients with apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial: an analysis from a multicenter, international study of ST-elevation myocardial infarction.
机构信息
Cardiovascular Sciences Research Centre, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom.
出版信息
Catheter Cardiovasc Interv. 2014 Feb 15;83(3):343-8. doi: 10.1002/ccd.23441. Epub 2013 Oct 21.
OBJECTIVES
To determine the incidence, clinical characteristics, and the coronary angiographic features of patients with apical ballooning syndrome (ABS) among those recruited into a large, prospective, international, multicenter trial.
BACKGROUND
ABS is an important entity in the differential diagnosis of ST-elevation myocardial infarction (STEMI). Current data regarding ABS are limited to single center registries.
METHODS
Patients with ABS were identified, based on the Mayo Clinic diagnostic criteria, from those enrolled into the HORIZONS-AMI trial. Quantitative angiography was performed by a core laboratory to identify the frequency and severity of coronary artery disease.
RESULTS
Among the 2,648 patients who had left ventriculography in addition to coronary angiography, 12 patients were identified with ABS. All patients were female and they were compared to the remaining 571 female patients with STEMI. Compared with patients with STEMI (97.9% of our cohort), patients with ABS (2.1%) had a lower prevalence (42% vs. 100%, P < 0.05) and severity (number of plaques measuring >30% diameter stenosis per patient: 0.58 ± 0.90 vs. 4.13 ± 2.68, P < 0.0001) of coronary artery disease. There were no in-hospital deaths or major adverse cardiovascular events (MACE) in the ABS group vs. 2.1% and 3.7% respectively in the STEMI group, nor at 2-year follow up (death: 0% vs. 5.5%, MACE: 0% vs. 19.4%), but these differences were not statistically significant.
CONCLUSIONS
In HORIZONS-AMI, ABS was identified exclusively in women (2.1% of female patients, 0.5% of all patients) and MACE were absent in this uncommon but important group of patients. Coronary artery disease was often present in patients with ABS, but its prevalence and severity was significantly less compared with STEMI patients.
目的
在一项大型前瞻性国际多中心试验中，确定入选患者中心尖球囊综合征（ABS）的发生率、临床特征和冠状动脉造影特征。
背景
ABS 是 ST 段抬高型心肌梗死（STEMI）鉴别诊断中的一个重要实体。目前关于 ABS 的数据仅限于单中心注册。
方法
根据梅奥诊所的诊断标准，从 HORIZONS-AMI 试验中入选的患者中确定 ABS 患者。通过核心实验室进行定量血管造影，以确定冠状动脉疾病的频率和严重程度。
结果
在进行左心室造影和冠状动脉造影的 2648 例患者中，发现 12 例 ABS 患者。所有患者均为女性，与 STEMI 组中的 571 例女性患者进行比较。与 STEMI 患者（我们队列的 97.9%）相比，ABS 患者（2.1%）的患病率（42% vs. 100%，P < 0.05）和严重程度（每位患者测量 >30%直径狭窄的斑块数量：0.58 ± 0.90 vs. 4.13 ± 2.68，P < 0.0001）均较低。ABS 组无院内死亡或主要不良心血管事件（MACE），而 STEMI 组分别为 2.1%和 3.7%，在 2 年随访时也无死亡或 MACE（死亡：0% vs. 5.5%，MACE：0% vs. 19.4%），但这些差异无统计学意义。
结论
在 HORIZONS-AMI 中，ABS 仅在女性（女性患者的 2.1%，所有患者的 0.5%）中发现，且在这个罕见但重要的患者群体中无 MACE。尽管 ABS 患者常存在冠状动脉疾病，但与 STEMI 患者相比，其患病率和严重程度明显较低。
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