The Heart Center of Chonnam National University Hospital, Gwangju, Korea.
Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Korea.
Korean J Intern Med. 2019 Sep;34(5):1040-1049. doi: 10.3904/kjim.2018.056. Epub 2018 Sep 1.
BACKGROUND/AIMS: Although cardiovascular (CV) risk factors are well established, some patients experience acute myocardial infarction (AMI) even without any risk factors.
We analyzed total 11,390 patients (63.6 ± 12.6 years old, 8,401 males) with AMI enrolled in Korea Acute Myocardial Infarction Registry-National Institute of Health from November, 2011 to December, 2015. Patients were divided into two groups according to the presence of any CV risk factors (group I, without risk factors, n = 1,420 [12.5%]; group II, with risk factors, n = 9,970 [87.5%]). In-hospital outcomes were defined as in-hospital mortality and complications. One-year clinical outcomes were defined as the composite of major adverse cardiac events (MACE).
Group I was older (67.3 ± 11.6 years old vs. 63.0 ± 12.7 years old, p < 0.001) and had higher prevalence of female gender (36.2% vs. 24.8%, p < 0.001) than the group II. Group I experienced less previous history of angina pectoris (7.0% vs. 9.4%, p = 0.003) and the previous history of cerebrovascular accidents (3.4% vs. 6.9%, p < 0.001). In-hospital mortality (2.6% vs. 3.0%, p = 0.450) and complications (20.6% vs. 20.0%, p = 0.647) were no differences between the groups. And 1 year clinical outcomes (5.7% vs. 5.1%, p = 0.337) were no differences between the groups. In multivariate logistic regression analysis, serum creatinine level (hazard ratio, 1.35; 95% confidence interval, 1.05 to 1.75; p = 0.021) were independent predictors of 1 year MACE in patients without any CV risk factors.
Elderly female patients were prone to develop AMI even without any modifiable CV risk factors. We suggest that more intensive care is needed in AMI patients without any CV risk factors who have high serum creatinine levels.
背景/目的：尽管心血管（CV）危险因素已经得到很好的确定，但有些患者即使没有任何危险因素也会发生急性心肌梗死（AMI）。
我们分析了 2011 年 11 月至 2015 年 12 月期间在韩国急性心肌梗死注册研究-国立卫生研究院中登记的 11390 例 AMI 患者（63.6±12.6 岁，8401 例男性）。根据是否存在任何 CV 危险因素将患者分为两组（I 组，无危险因素，n=1420[12.5%]；II 组，有危险因素，n=9970[87.5%]）。住院期间的结局定义为住院死亡率和并发症。1 年临床结局定义为主要不良心脏事件（MACE）的复合结局。
I 组患者年龄较大（67.3±11.6 岁 vs. 63.0±12.7 岁，p<0.001），女性比例较高（36.2% vs. 24.8%，p<0.001）。I 组患者心绞痛史（7.0% vs. 9.4%，p=0.003）和脑血管意外史（3.4% vs. 6.9%，p<0.001）较少。两组间住院死亡率（2.6% vs. 3.0%，p=0.450）和并发症（20.6% vs. 20.0%，p=0.647）无差异。两组间 1 年临床结局（5.7% vs. 5.1%，p=0.337）亦无差异。多变量 logistic 回归分析显示，血清肌酐水平（危险比，1.35；95%置信区间，1.05 至 1.75；p=0.021）是无任何 CV 危险因素患者 1 年 MACE 的独立预测因素。
年龄较大的女性患者即使没有任何可改变的 CV 危险因素也易发生 AMI。我们建议，对于血清肌酐水平较高且无任何 CV 危险因素的 AMI 患者，需要进行更强化的治疗。
