Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, Ohio.
Internal Medicine Detroit Medical Center/Wayne State University, Michigan; Internal Medicine, Baptist Health System, Montgomery, Alabama.
Am J Cardiol. 2022 May 15;171:23-27. doi: 10.1016/j.amjcard.2022.01.059. Epub 2022 Mar 21.
This study aimed to study group differences in patients presenting with ST-elevation myocardial infarction (STEMI) based on the presence or absence of associated coronary artery aneurysms (CAA). The cause-and-effect relationship between CAAs and STEMI is largely unknown. The Nationwide Readmission database was used to identify and study group differences of patients with STEMI and with and without CAA from 2014 to 2018. The primary outcome in the 2 groups was mortality. Secondary outcomes in the 2 groups included differences in clinical outcomes, cardiovascular interventions performed, and prevalence of coronary artery dissection. The total number of patients with STEMI included was 1,038,299. In this sample, 1,543 (0.15%) had CAA. Compared with those without CAA, patients with CAAs and STEMI were younger (62.6 vs 65.4), more likely to be male (78 vs 66%), and had a higher prevalence of a history of Kawasaki disease (2.5 vs 0.01%). A difference exists in the prevalence of coronary dissection in patients with STEMI with and without CAA (73% vs 1%). Patients with CAA were more often treated with coronary artery bypass grafting (13.1 vs 5.6%), thrombectomy (16.5 vs 6%), and bare-metal stent implantation (8 vs 4.4). Patients in the CAA STEMI group had lower all-cause mortality (6.3 vs 11.7%). In conclusion, there are important differences in patients with STEMI with and without CAA, which include, but are not limited to, factors such as patient profile, the risk for coronary dissection, treatment, outcomes, and mortality.
本研究旨在研究基于是否存在相关冠状动脉瘤（CAA）的 ST 段抬高型心肌梗死（STEMI）患者的组间差异。CAA 和 STEMI 之间的因果关系在很大程度上尚不清楚。使用全国再入院数据库，从 2014 年至 2018 年，确定并研究了 STEMI 患者和有或无 CAA 的患者的组间差异。两组的主要结局是死亡率。两组的次要结局包括临床结局、心血管介入治疗和冠状动脉夹层的发生率的差异。包括的 STEMI 患者总数为 1,038,299 例。在该样本中，1,543 例（0.15%）存在 CAA。与无 CAA 的患者相比，患有 CAA 和 STEMI 的患者年龄更小（62.6 岁比 65.4 岁），更可能为男性（78%比 66%），且更易患有川崎病病史（2.5%比 0.01%）。存在 CAA 的 STEMI 患者和无 CAA 的 STEMI 患者的冠状动脉夹层发生率存在差异（73%比 1%）。患有 CAA 的患者更常接受冠状动脉旁路移植术（13.1%比 5.6%）、血栓切除术（16.5%比 6%）和裸金属支架植入术（8%比 4.4%）。CAA STEMI 组患者的全因死亡率较低（6.3%比 11.7%）。总之，存在 CAA 和无 CAA 的 STEMI 患者存在重要差异，包括但不限于患者特征、冠状动脉夹层风险、治疗、结局和死亡率。
