Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China.
Department of Cardiology, The Key Laboratory of Cardiovascular Disease of Wenzhou, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, PR China.
Am J Emerg Med. 2020 Jun;38(6):1185-1191. doi: 10.1016/j.ajem.2020.03.043. Epub 2020 Mar 24.
Several studies have indicated that acute myocardial infarction (AMI) secondary to coronary artery embolism (CE) has a poor prognosis. However, in the latter studies, CE of tumor origin accounts for a considerable proportion of cases and the clinical features and contribution to overall prognosis of non-tumor CE are unknown and therefore the subject of this study.
We retrospectively studied 2006 consecutive patients with AMI at our medical center from January 2014 to October 2018. Non-tumor CE was diagnosed based on angiographic, biochemical, and imaging criteria. Patients were divided into two groups: patients without CE (control) and patients with non-tumor CE.
Atrial fibrillation was the most frequent etiology (n = 32, 69.6%) in the non-tumor CE group (n = 46). Compared with the control group, the non-tumor CE group had (all p < 0.05): higher incidence of atrial fibrillation; larger left atrial diameter, left ventricular end-diastolic diameter and left ventricular end-systolic diameter; lower left ventricular ejection fraction, ST-segment-elevation myocardial infarction incidence and low density lipoprotein cholesterol level; lower incidence of multivessel coronary stenosis, level of culprit lesion stenosis and proportion of angioplasty; higher ratio of manual thrombectomy and antithrombotic drugs alone therapy; lower thrombolysis in myocardial infarction (TIMI) grade and higher corrected TIMI frame counts (CTFC) after reperfusion; and statistically similar overall survival at median 864 (interquartile range, 413-1272) days.
The overall incidence of non-tumor CE was 2.3%, with atrial fibrillation as its most common etiology. Midterm overall survival was similar between AMI patients secondary to non-tumor CE and those without CE.
多项研究表明，由冠状动脉栓塞（CE）引起的急性心肌梗死（AMI）预后较差。然而，在后一项研究中，肿瘤来源的 CE 占相当大的比例，而非肿瘤 CE 的临床特征及其对总体预后的贡献尚不清楚，因此本研究的主题。
我们回顾性研究了 2006 例 2014 年 1 月至 2018 年 10 月在我院就诊的 AMI 患者。根据血管造影、生化和影像学标准诊断非肿瘤性 CE。患者分为两组：无 CE 患者（对照组）和非肿瘤性 CE 患者。
非肿瘤性 CE 组（n=46）最常见的病因是心房颤动（n=32，69.6%）。与对照组相比，非肿瘤性 CE 组具有以下特点（均 P<0.05）：心房颤动发生率较高；左心房直径、左心室舒张末期直径和左心室收缩末期直径较大；左心室射血分数、ST 段抬高型心肌梗死发生率和低密度脂蛋白胆固醇水平较低；多支冠状动脉狭窄、罪犯病变狭窄程度和经皮冠状动脉介入治疗比例较低；手动血栓切除术和单独抗血栓药物治疗的比例较高；溶栓治疗后心肌梗死（TIMI）分级和校正 TIMI 帧数（CTFC）较高；中位随访 864 天（四分位间距，413-1272 天）的总生存率相似。
非肿瘤性 CE 的总发生率为 2.3%，心房颤动是其最常见的病因。非肿瘤性 CE 引起的 AMI 患者与无 CE 患者的中期总体生存率相似。
