Department of Medicine, New York Medical College, Valhalla, NY.
Division of Cardiology, New York Medical College, Valhalla.
Am J Med. 2015 Aug;128(8):879-887.e1. doi: 10.1016/j.amjmed.2015.02.025. Epub 2015 Apr 22.
Acute myocardial infarction is a recognized complication in patients with hypertrophic cardiomyopathy. However, limited data are available on outcomes of patients with hypertrophic cardiomyopathy and acute myocardial infarction.
We analyzed the 2003-2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years with a principal diagnosis of acute myocardial infarction. Patients with a concomitant diagnosis of hypertrophic cardiomyopathy were then identified and analyzed as a separate cohort. Multivariate logistic regression was used to compare outcomes in patients with acute myocardial infarction with and without hypertrophic cardiomyopathy.
Of 5,901,827 patients with acute myocardial infarction, 5688 (0.1%) had a diagnosis of hypertrophic cardiomyopathy. Patients with hypertrophic cardiomyopathy were older, more likely to be female, and less likely to have traditional cardiovascular risk factors. Compared with patients without hypertrophic cardiomyopathy, patients with hypertrophic cardiomyopathy were less likely to present with ST-elevation myocardial infarction and more likely to present with non-ST-elevation myocardial infarction. Patients with hypertrophic cardiomyopathy with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction were less likely to receive revascularization. In the overall population with acute myocardial infarction, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.84-1.11; P = .59). In the population with ST-elevation myocardial infarction, patients with hypertrophic cardiomyopathy had lower risk-adjusted in-hospital mortality than those without hypertrophic cardiomyopathy (OR, 0.75; 95% CI, 0.63-0.91; P = .003), whereas in the population with non-ST-elevation myocardial infarction, there was no difference in risk-adjusted in-hospital mortality between patients with and without hypertrophic cardiomyopathy (OR, 0.97; 95% CI, 0.84-1.11; P = .63).
Patients with hypertrophic cardiomyopathy represent a small proportion of patients with acute myocardial infarction and are less likely to receive revascularization. Compared with patients without hypertrophic cardiomyopathy, patients with hypertrophic cardiomyopathy with ST-elevation myocardial infarction have lower risk-adjusted in-hospital mortality.
急性心肌梗死是肥厚型心肌病患者公认的并发症。然而，关于肥厚型心肌病合并急性心肌梗死患者的结局，目前仅有有限的数据。
我们分析了 2003 年至 2011 年全国住院患者样本数据库，以确定所有年龄≥18 岁、主要诊断为急性心肌梗死的患者。然后确定并分析伴有肥厚型心肌病的患者，将其作为单独队列进行分析。采用多变量逻辑回归比较合并和不合并肥厚型心肌病的急性心肌梗死患者的结局。
在 5901827 例急性心肌梗死患者中，5688 例（0.1%）有肥厚型心肌病的诊断。患有肥厚型心肌病的患者年龄较大，更可能为女性，且传统心血管危险因素较少。与无肥厚型心肌病的患者相比，有肥厚型心肌病的患者更不可能表现为 ST 段抬高型心肌梗死，而更可能表现为非 ST 段抬高型心肌梗死。ST 段抬高型或非 ST 段抬高型心肌梗死合并肥厚型心肌病的患者接受血运重建的可能性较小。在整体急性心肌梗死患者中，合并和不合并肥厚型心肌病的患者在风险调整的院内死亡率方面无差异（比值比[OR]，0.96；95%置信区间[CI]，0.84-1.11；P=.59）。在 ST 段抬高型心肌梗死患者中，患有肥厚型心肌病的患者的风险调整的院内死亡率低于不患有肥厚型心肌病的患者（OR，0.75；95%CI，0.63-0.91；P=.003），而在非 ST 段抬高型心肌梗死患者中，患有和不患有肥厚型心肌病的患者的风险调整的院内死亡率无差异（OR，0.97；95%CI，0.84-1.11；P=.63）。
患有肥厚型心肌病的患者在急性心肌梗死患者中占比较小，且更不可能接受血运重建。与不患有肥厚型心肌病的患者相比，ST 段抬高型心肌梗死合并肥厚型心肌病的患者风险调整的院内死亡率更低。
