急性心肌梗死伴或不伴自发性冠状动脉夹层女性患者的发病率、临床表现和住院死亡率趋势：一项基于人群的分析。
Trends of Incidence, Clinical Presentation, and In-Hospital Mortality Among Women With Acute Myocardial Infarction With or Without Spontaneous Coronary Artery Dissection: A Population-Based Analysis.
机构信息
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida.
Department of Medicine, University of Missouri Kansas City, Kansas City, Missouri.
出版信息
JACC Cardiovasc Interv. 2018 Jan 8;11(1):80-90. doi: 10.1016/j.jcin.2017.08.016. Epub 2017 Dec 13.
OBJECTIVES
The authors sought to determine the clinical characteristics and in-hospital survival of women presenting with acute myocardial infarction (AMI) and spontaneous coronary artery dissection (SCAD).
BACKGROUND
The clinical presentation and in-hospital survival of women with AMI and SCAD remains unclear.
METHODS
The National Inpatient Sample (2009 to 2014) was queried for all women with a primary diagnosis of AMI and concomitant SCAD. Iatrogenic coronary dissection was excluded. The main outcome was in-hospital mortality. Propensity score matching and multivariable logistic regression analyses were performed.
RESULTS
Among 752,352 eligible women with AMI, 7,347 had a SCAD diagnosis. Women with SCAD were younger (61.7 vs. 67.1 years of age) with less comorbidity. SCAD was associated with higher incidence of in-hospital mortality (6.8% vs. 3.4%). In SCAD patients, a decrease in in-hospital mortality was evident with time (11.4% in 2009 vs. 5.0% in 2014) and concurred with less percutaneous coronary intervention (PCI) (82.5% vs. 69.1%). Propensity score yielded 7,332 SCAD and 14,352 patients without SCAD. The odds ratio (OR) of in-hospital mortality remained higher with SCAD after propensity matching (OR: 1.87, 95% confidence interval [CI]: 1.65 to 2.11) and on multivariable regression analyses (OR: 2.41, 95% CI: 2.07 to 2.80). PCI was associated with higher mortality in SCAD patients presenting with non-ST-segment elevation myocardial infarction (OR: 2.01; 95% CI: 1.00 to 4.47), but not with STEMI (OR: 0.62; 95% CI: 0.41 to 0.96).
CONCLUSIONS
Women presenting with AMI and SCAD appear to be at higher risk of in-hospital mortality. Lower rates of PCI were associated with improved survival, with evidence of worse outcomes when PCI was performed for SCAD in the setting of non with ST-segment elevation myocardial infarction.
目的
作者旨在确定急性心肌梗死（AMI）和自发性冠状动脉夹层（SCAD）女性患者的临床特征和院内生存率。
背景
女性 AMI 和 SCAD 患者的临床表现和院内生存率仍不清楚。
方法
通过 2009 年至 2014 年的国家住院患者样本（National Inpatient Sample），对所有原发性 AMI 合并 SCAD 的女性患者进行了查询。排除医源性冠状动脉夹层。主要结局是院内死亡率。进行倾向评分匹配和多变量逻辑回归分析。
结果
在 752352 名符合条件的 AMI 女性中，有 7347 名患有 SCAD 诊断。SCAD 患者年龄更小（61.7 岁 vs. 67.1 岁），合并症更少。SCAD 与更高的院内死亡率相关（6.8% vs. 3.4%）。在 SCAD 患者中，随着时间的推移，院内死亡率呈下降趋势（2009 年为 11.4%，2014 年为 5.0%），同时经皮冠状动脉介入治疗（PCI）减少（82.5% vs. 69.1%）。倾向评分得出 7332 例 SCAD 和 14352 例无 SCAD 患者。在倾向匹配后，SCAD 患者的院内死亡率仍然较高（比值比 [OR]：1.87，95%置信区间 [CI]：1.65 至 2.11），在多变量回归分析中也是如此（OR：2.41，95% CI：2.07 至 2.80）。对于非 ST 段抬高型心肌梗死（STEMI）患者，SCAD 患者行 PCI 与更高的死亡率相关（OR：2.01；95% CI：1.00 至 4.47），但对于 STEMI 患者则不然（OR：0.62；95% CI：0.41 至 0.96）。
结论
患有 AMI 和 SCAD 的女性患者似乎有更高的院内死亡率风险。较低的 PCI 率与生存率的提高相关，当在非 STEMI 情况下对 SCAD 进行 PCI 时，证据表明预后更差。
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