Mittal Tarun K, Reichmuth Luise, Ariff Ben, Rao Praveen P G, Baltabaeva Aigul, Rahman-Haley Shelley, Kabir Tito, Wong Joyce, Dalby Miles
Department of Cardiology & Cardiac Imaging, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Department of Imaging, Mater Dei University Hospital, Malta, Malta.
Heart. 2016 Nov 1;102(21):1728-1734. doi: 10.1136/heartjnl-2015-309039. Epub 2016 Jul 1.
A proportion of patients with suspected ST-elevation myocardial infarction (STEMI) presenting for primary percutaneous coronary intervention (PPCI) do not have obstructive coronary disease and other conditions may be responsible for their symptoms and ECG changes. In this study, we set out to determine the prevalence and aetiology of alternative diagnoses in a large PPCI cohort as determined with multimodality imaging and their outcome.
From 2009 to 2012, 5238 patients with suspected STEMI were referred for consideration of PPCI. Patients who underwent angiography but had no culprit artery for revascularisation and no previous history of coronary artery disease were included in the study. Troponin values, imaging findings and all-cause mortality were obtained from hospital and national databases.
A total of 575 (13.0%) patients with a mean age of 58±15 years (69% men) fulfilled the inclusion criteria. A specific diagnosis based on imaging was made in 237 patients (41.2%) including cardiomyopathies (n=104, 18%), myopericarditis (n=48, 8.4%), myocardial infarction/other coronary abnormality (n=27, 4.9%) and severe valve disease (n=23, 4%). Pulmonary embolism and type A aortic dissection were identified in seven (1.2%) and four (0.7%) cases respectively. A total of 40 (7.0%) patients died over a mean follow-up of 42.6 months.
A variety of cardiac and non-cardiac conditions are prevalent in patients presenting with suspected STEMI but culprit-free angiogram, some of which may have adverse outcomes. Further imaging of such patients could thus be useful to help in appropriate management and follow-up.
一部分因疑似ST段抬高型心肌梗死（STEMI）而接受直接经皮冠状动脉介入治疗（PPCI）的患者并无阻塞性冠状动脉疾病，其他病症可能是其症状和心电图变化的原因。在本研究中，我们旨在确定一个大型PPCI队列中经多模态成像确定的替代诊断的患病率和病因及其结果。
2009年至2012年，5238例疑似STEMI患者被转诊考虑进行PPCI。接受血管造影但没有需要血运重建的罪犯血管且无冠状动脉疾病既往史的患者被纳入研究。肌钙蛋白值、影像学检查结果和全因死亡率从医院和国家数据库中获取。
共有575例（13.0%）平均年龄为58±15岁（69%为男性）的患者符合纳入标准。237例（41.2%）患者基于影像学做出了明确诊断，包括心肌病（n = 104，18%）、心肌心包炎（n = 48，8.4%）、心肌梗死/其他冠状动脉异常（n = 27，4.9%）和严重瓣膜疾病（n = 23，4%）。分别在7例（1.2%）和4例（0.7%）病例中发现了肺栓塞和A型主动脉夹层。在平均42.6个月的随访期内，共有40例（7.0%）患者死亡。
在疑似STEMI但血管造影无罪犯血管的患者中，各种心脏和非心脏病症很常见，其中一些可能有不良后果。因此，对这类患者进行进一步的影像学检查可能有助于进行适当的管理和随访。
