Abdelmonem Yasser Yazied, Bakr Adel Abdelgawad, El-Hossary Hossam Ghanem, Ghany Mohammed Mahmoud Abdel
Kasr Alainy, Department of Cardiology, Cairo University Hospitals, Cairo, Egypt.
Egypt Heart J. 2017 Sep;69(3):191-199. doi: 10.1016/j.ehj.2017.03.001. Epub 2017 May 8.
The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.
The present study aimed to investigate the clinical profile, in-hospital and 3-month outcome of AMI patients with insignificant coronary stenosis in comparison with those with significant disease.
This prospective observational study included 200 consecutive patients admitted with AMI. Group I (100 patients) included patients with insignificant CAD (all lesions <50% stenosis). Group II (100 patients) included patients with one or more lesions >70% stenosis. Patients with previous CABG were excluded. Patients with significant CAD had successful total revascularization.
Patients with insignificant CAD were significantly younger (61 vs. 67 years, p < 0.001), more likely to be females (41% vs. 23%, p = 0.006), less likely to smoke (p = 0.006), less likely to have diabetes mellitus (p < 0.001), and less likely to have history of CAD (p = 0.042) or prior PCI (p = 0.037). They were also less likely to have typical anginal pain at presentation (61% vs 91%, p < 0.001), less likely to have heart failure at presentation (9% vs 30%, p < 0.001), less likely to have ischemic ST-segment changes on presentation (10% vs 46%, p < 0.001), lower peak troponin (p < 0.001) and CK-MB levels (p < 0.001), with lower LDL-C (p = 0.006), and higher HDL-C level (p = 0.020). They were less likely to be treated with b-blockers (p = 0.002), ACEI/ARBS (p = 0.007), and higher rates of calcium channel blocker therapy (p < 0.001). They had lower prevalence of major adverse clinical events at follow-up (readmission for ACS (p = 0.009), need for revascularization (p = 0.035), recurrent chest pain (p = 0.009), and cardiogenic shock (p = 0.029).
Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.
急性心肌梗死（AMI）且冠状动脉狭窄不显著患者的特征尚不清楚。
本研究旨在调查冠状动脉狭窄不显著的AMI患者与冠状动脉狭窄显著的患者相比的临床特征、住院期间及3个月的结局。
这项前瞻性观察性研究纳入了200例连续收治的AMI患者。第一组（100例患者）包括冠状动脉疾病不显著（所有病变狭窄<50%）的患者。第二组（100例患者）包括有一处或多处病变狭窄>70%的患者。既往有冠状动脉旁路移植术（CABG）的患者被排除。冠状动脉狭窄显著的患者成功实现了完全血运重建。
冠状动脉疾病不显著的患者明显更年轻（61岁对67岁，p<0.001），更可能为女性（41%对23%，p=0.006），吸烟可能性更小（p=0.006），患糖尿病可能性更小（p<0.001），有冠状动脉疾病史（p=0.042）或既往经皮冠状动脉介入治疗（PCI）史（p=0.037）的可能性更小。他们在就诊时出现典型心绞痛的可能性也更小（61%对91%，p<0.001），就诊时发生心力衰竭的可能性更小（9%对30%，p<0.001），就诊时出现缺血性ST段改变的可能性更小（10%对46%，p<0.001），肌钙蛋白峰值更低（p<0.001）和肌酸激酶同工酶（CK-MB）水平更低（p<0.001），低密度脂蛋白胆固醇（LDL-C）更低（p=0.006），高密度脂蛋白胆固醇（HDL-C）水平更高（p=0.020）。他们接受β受体阻滞剂治疗的可能性更小（p=0.002），接受血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂（ACEI/ARBs）治疗的可能性更小（p=0.007），而钙通道阻滞剂治疗率更高（p<0.001）。他们在随访时主要不良临床事件的发生率更低（因急性冠状动脉综合征（ACS）再次入院（p=0.009）、需要血运重建（p=0.035）、复发性胸痛（p=0.009）和心源性休克（p=0.029））。
与冠状动脉狭窄显著的患者相比，AMI且冠状动脉狭窄不显著的患者具有不同的临床特征和结局。
