Grodzinsky Anna, Arnold Suzanne V, Gosch Kensey, Spertus John A, Foody JoAnne M, Beltrame John, Maddox Thomas M, Parashar Susmita, Kosiborod Mikhail
Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
Eur Heart J Qual Care Clin Outcomes. 2015;1(2):92-99. doi: 10.1093/ehjqcco/qcv014. Epub 2015 Jul 23.
Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) are at increased risk for recurrent ischemic events, but angina frequency post-MI has not been described.
Among MI patients who underwent angiography, we assessed angina at baseline, 1, 6, and 12 months using the Seattle Angina Questionnaire (SAQ). A hierarchical repeated measures modified Poisson model assessed the association between the absence of obstructive CAD (defined as epicardial stenoses >70% or left main >50%) and angina. Among 5539 MI patients from 31 US hospitals (mean age 60, 68% male), 6.9% had no angiographic obstructive CAD. More patients without obstructive CAD (vs. obstructive CAD) were female (57% vs 30%), non-white (51% vs 24%) and had NSTEMI (87% vs 51%). In unadjusted analyses, patients without obstructive CAD had less angina prior to MI but more angina and worse health status post-discharge. After adjustment for socio-demographic and clinical factors, the risk of post-MI angina was similar in patients without vs. with obstructive CAD (IRR=0.89, 95% CI 0.77-1.02). Among patients without obstructive CAD, depression and self-reported avoidance of care due to cost were independently associated with angina (IRR=1.28 per 5 points on PHQ, 95% CI 1.17-1.41; IRR=1.34, 95% 1.02-1.1.74).
Following MI, patients without obstructive CAD experience an angina burden at least as high as those with obstructive CAD, affecting 1 in 4 patients at 12 months. As these patients are not candidates for revascularization, other anti-anginal strategies are needed to improve their health status and quality of life.
无阻塞性冠状动脉疾病（CAD）的心肌梗死（MI）患者发生复发性缺血事件的风险增加，但MI后心绞痛的发作频率尚未见报道。
在接受血管造影的MI患者中，我们使用西雅图心绞痛问卷（SAQ）在基线、1个月、6个月和12个月时评估心绞痛情况。采用分层重复测量修正泊松模型评估无阻塞性CAD（定义为心外膜狭窄>70%或左主干狭窄>50%）与心绞痛之间的关联。在美国31家医院的5539例MI患者（平均年龄60岁，68%为男性）中，6.9%没有血管造影显示的阻塞性CAD。无阻塞性CAD的患者（与有阻塞性CAD的患者相比）女性更多（57%对30%）、非白人更多（51%对24%）且非ST段抬高型心肌梗死（NSTEMI）更多（87%对51%）。在未经调整的分析中，无阻塞性CAD的患者在MI前心绞痛较少，但出院后心绞痛较多且健康状况较差。在对社会人口统计学和临床因素进行调整后，无阻塞性CAD的患者与有阻塞性CAD的患者发生MI后心绞痛的风险相似（发病率比[IRR]=0.89，95%置信区间[CI] 0.77 - 1.02）。在无阻塞性CAD的患者中，抑郁以及因费用问题自我报告的避免就医与心绞痛独立相关（PHQ每增加5分，IRR = 1.28，95% CI 1.17 - 只有1.41；IRR = 1.34，95% CI 1.02 - 1.1.74）。
MI后，无阻塞性CAD的患者经历的心绞痛负担至少与有阻塞性CAD的患者一样高，12个月时每4名患者中有1名受影响。由于这些患者不适合进行血运重建，需要其他抗心绞痛策略来改善他们的健康状况和生活质量。 （注：原文中“95% CI 1.02 - 1.1.74”表述似乎有误，这里按原文翻译）
