Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Am J Med. 2018 May;131(5):524-531.e6. doi: 10.1016/j.amjmed.2017.12.008. Epub 2017 Dec 26.
Approximately 5% to 10% of all patients with myocardial infarction have nonobstructive coronary arteries. Studies investigating the importance of follow-up and achievement of conventional secondary prevention targets in these patients are lacking.
In this analysis from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we investigated 5830 patients with myocardial infarction with nonobstructive coronary arteries (group 1) and 54,637 patients with myocardial infarction with significant coronary artery disease (≥50% stenosis; group 2). Multivariable- and propensity score-adjusted statistics were used to assess the reduction in the 1-year risk of major adverse events associated with prespecified secondary preventive measures: participation in follow-up at 6 to 10 weeks after the hospitalization and achievement of secondary prevention targets (blood pressure and low-density lipoprotein cholesterol levels in the target ranges, nonsmoking, and participation in exercise training).
Patients in group 1 were less often followed up compared with patients in group 2 and less often achieved any of the secondary prevention targets. Participation in the 6- to 10-week follow-up was associated with a 3% to 20% risk reduction in group 1, similar as for group 2 according to interaction analysis. The improvement in outcome in group 1 was mainly mediated by achieving target range low-density lipoprotein cholesterol levels (24%-32% risk reduction) and, to a smaller extent, by participation in exercise training (10%-23% risk reduction).
Selected secondary preventive measures are associated with prognostic benefit in patients with myocardial infarction with nonobstructive coronary arteries, in particular achieving target range low-density lipoprotein cholesterol levels. Our results indicate that these patients should receive similar follow-up as myocardial infarction patients with significant coronary stenoses.
约 5%-10%的心肌梗死患者存在非阻塞性冠状动脉病变。目前缺乏针对这些患者进行随访和实现传统二级预防目标重要性的研究。
本研究是对瑞典 Web 系统增强和发展基于证据的心脏病治疗评估（SWEDEHEART）注册中心进行的分析，共纳入 5830 例非阻塞性冠状动脉病变心肌梗死患者（第 1 组）和 54637 例有显著冠状动脉疾病（≥50%狭窄；第 2 组）的患者。采用多变量和倾向评分调整统计方法评估与特定二级预防措施相关的 1 年主要不良事件风险降低情况：在住院后 6-10 周时参加随访，以及实现二级预防目标（血压和低密度脂蛋白胆固醇水平达到目标范围、不吸烟和参加运动训练）。
与第 2 组相比，第 1 组患者接受随访的比例较低，实现任何二级预防目标的比例也较低。参加 6-10 周随访与第 1 组的风险降低 3%-20%相关，根据交互分析，这一结果与第 2 组相似。第 1 组预后的改善主要是通过达到目标范围的低密度脂蛋白胆固醇水平（降低 24%-32%的风险），以及在较小程度上通过参加运动训练（降低 10%-23%的风险）实现的。
在非阻塞性冠状动脉病变的心肌梗死患者中，某些二级预防措施与预后获益相关，特别是达到目标范围的低密度脂蛋白胆固醇水平。我们的结果表明，这些患者应接受与有显著冠状动脉狭窄的心肌梗死患者类似的随访。
