与患有阻塞性冠状动脉疾病的患者相比，因急性心肌梗死入院的非阻塞性冠状动脉疾病患者的预后更好。
Patients with non-obstructive coronary artery disease admitted with acute myocardial infarction carry a better outcome compared to those with obstructive coronary artery disease.
作者信息
Abdelmonem Yasser Yazied, Bakr Adel Abdelgawad, El-Hossary Hossam Ghanem, Ghany Mohammed Mahmoud Abdel
机构信息
Kasr Alainy, Department of Cardiology, Cairo University Hospitals, Cairo, Egypt.
出版信息
Egypt Heart J. 2017 Sep;69(3):191-199. doi: 10.1016/j.ehj.2017.03.001. Epub 2017 May 8.
BACKGROUND
The characterization of patients who have acute myocardial infarction (AMI) and insignificant coronary stenosis is unclear.
AIM
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.
METHODS
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.
RESULTS
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).
CONCLUSION
Patients with AMI and insignificant CAD have different clinical profile and outcome compared to those with significant disease.
背景
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。
目的
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。
方法
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。
结果
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））。
结论
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。
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