Barr Peter R, Harrison Wil, Smyth David, Flynn Charmaine, Lee Mildred, Kerr Andrew J
Cardiology Department, Middlemore Hospital, Auckland, New Zealand.
Cardiology Department, Middlemore Hospital, Auckland, New Zealand.
Heart Lung Circ. 2018 Feb;27(2):165-174. doi: 10.1016/j.hlc.2017.02.023. Epub 2017 Mar 30.
Non-obstructive coronary artery disease (CAD) on coronary angiography after myocardial infarction (MI) is associated with a lower risk of adverse outcomes, but the prognosis may not be benign. Our aim was to assess outcomes in MI with and without obstructive CAD, and in an age and sex matched comparison cohort without known cardiovascular disease.
We performed a single centre analysis of consecutive patients undergoing coronary angiography for MI between 2007 and 2012. Patients were classified into those with obstructive CAD (≥50% epicardial coronary artery stenosis) and those without obstructive CAD (<50%). Myocardial infarction patient data was collected in an electronic registry and linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD were identified from the community PREDICT cohort.
Of the 2070 patients with MI, 302 (15%) had non-obstructive CAD. Compared to patients with obstructive disease they were younger (mean 57 v 61 years, p<0.001), more likely to be women (50% vs 23%, p<0.001), to be of Maori or Pacific vs. European ethnicity (p<0.001), more likely to be lifelong non-smokers (46% v 38%, p=0.02), non-diabetic (80v 73%, p <0.01), have no ST-segment deviation (78% v 46%, p<0.001), and have a low risk Global Registry of Acute Coronary Events acute coronary syndrome (GRACE ACS) score (54 v 35%, p<0.001). They were also less likely to receive 'triple therapy' secondary prevention medications (81% v 94%, p<0.0001). The cumulative two-year Kaplan-Maier composite outcome of mortality or non-fatal MI was 14.3% for MI with obstructive CAD, 4.6% for MI without obstructive disease, and 2.2% for patients without prior CVD (p<0.001).
Myocardial infarction without obstructive coronary disease is common (∼1 in 7 patients) and is not clinically benign, with an adverse outcome rate double that of age and sex matched patients without CVD.
心肌梗死（MI）后冠状动脉造影显示非阻塞性冠状动脉疾病（CAD）与不良结局风险较低相关，但预后可能并非良性。我们的目的是评估有无阻塞性CAD的MI患者以及年龄和性别匹配的无已知心血管疾病的对照队列的结局。
我们对2007年至2012年间因MI接受冠状动脉造影的连续患者进行了单中心分析。患者被分为阻塞性CAD（≥50%心外膜冠状动脉狭窄）和无阻塞性CAD（<50%）两组。心肌梗死患者的数据收集在电子登记册中，并与国家住院和死亡率记录进行匿名关联。从社区PREDICT队列中识别出年龄和性别匹配的无已知心血管疾病的患者。
在2070例MI患者中，302例（15%）患有非阻塞性CAD。与阻塞性疾病患者相比，他们更年轻（平均57岁对61岁，p<0.001），女性比例更高（50%对23%，p<0.001），毛利人或太平洋岛民与欧洲族裔的比例更高（p<0.001），更有可能是终生不吸烟者（46%对38%，p=0.02），非糖尿病患者（80%对73%，p<0.01），无ST段偏移（78%对46%，p<0.001），且急性冠状动脉综合征全球注册研究（GRACE ACS）风险评分较低（54%对35%，p<0.001）。他们接受“三联疗法”二级预防药物的可能性也较小（81%对94%，p<0.0001）。阻塞性CAD的MI患者两年累积Kaplan-Maier复合结局（死亡率或非致命性MI）为14.3%，无阻塞性疾病的MI患者为4.6%，无既往心血管疾病的患者为2.2%（p<0.001）。
无阻塞性冠状动脉疾病的心肌梗死很常见（约7例中有1例），且临床并非良性，不良结局发生率是年龄和性别匹配的无心血管疾病患者的两倍。
