非ST段抬高型急性冠状动脉综合征的性别特殊性及非典型临床表现的患病率

Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome.

作者信息

Negrea Mihai Octavian, Zdrenghea Dumitru, Teodoru Minodora, Neamțu Bogdan, Cipăian Călin Remus, Pop Dana

机构信息

Faculty of Medicine, "Lucian Blaga" University, 550024 Sibiu, Romania.

Fifth Department of Internal Medicine, Cardiology Rehabilitation, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.

出版信息

J Cardiovasc Dev Dis. 2022 Mar 14;9(3):84. doi: 10.3390/jcdd9030084.

DOI:10.3390/jcdd9030084

PMID:35323632

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8955041/

Abstract

Clinical presentation is one of the factors that can influence how quickly a patient with an acute coronary syndrome is treated, particularly if it is atypical. The purposes of this study are to explore gender-related differences in patients presenting with non-ST elevation acute coronary syndromes (NSTEACS) from the perspective of a series of common risk factors as well as treatment strategies and to evaluate the prevalence of atypical clinical presentation of NSTEACS in the study group. In addition, we explored the differences between the two entities that define NSTEACS: unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI). We conducted a retrospective study by reviewing discharge documents of patients admitted in the cardiology department of the Clinical Rehabilitation Hospital in Cluj-Napoca with NSTEACS between January 2014 and December 2015. We retrieved demographic data, clinical presentation and history, laboratory tests, and coronary angiography records as well as the implemented treatment strategies. Women in the study group were more frequently hypertensive than men (89.5% vs. 75.4%; = 0.043), had a higher mean serum HDL cholesterol value (43 vs. 38 mg/dL = 0.022), were more frequently diagnosed with microvascular coronary heart disease (32% vs. 9.8%, = 0.036), and were more often treated conservatively (49.1% vs. 30.8%, = 0.038), while men were significantly more prone to smoking than women (30.8% vs. 14%, = 0.028) and had higher mean serum creatinine (1.2 vs. 0.8 mg/dL; = 0.022) and uric acid values (6.9 vs. 6.2 mg/dL; = 0.048). Out of the 122 included patients, 109 had documented information regarding symptoms. The prevalence of atypical presentation was 4.6% (95% CI 0.7-8.5%). In our study group, patients with UA had a more frequent history of cardiovascular ischemic diseases (77.4% vs. 56.7%, = 0.015), the mean value for BUN was higher in NSTEMI patients compared to patients with UA (47 vs. 39 mg/dL, = 0.038) and NSTEMI patients more frequently received interventional treatment compared to patients with UA (60% vs. 41.9%; = 0.046).

摘要

临床表现是影响急性冠状动脉综合征患者治疗速度的因素之一，尤其是在临床表现不典型的情况下。本研究的目的是从一系列常见危险因素以及治疗策略的角度，探讨非ST段抬高型急性冠状动脉综合征（NSTEACS）患者中与性别相关的差异，并评估研究组中NSTEACS非典型临床表现的患病率。此外，我们还探讨了定义NSTEACS的两个实体——不稳定型心绞痛（UA）和非ST段抬高型心肌梗死（NSTEMI）之间的差异。我们通过回顾2014年1月至2015年12月在克卢日-纳波卡临床康复医院心内科住院的NSTEACS患者的出院文件进行了一项回顾性研究。我们获取了人口统计学数据、临床表现和病史、实验室检查、冠状动脉造影记录以及实施的治疗策略。研究组中的女性高血压患者比男性更常见（89.5%对75.4%；P = 0.043），平均血清高密度脂蛋白胆固醇值更高（43对38mg/dL，P = 0.022），更常被诊断为微血管性冠心病（32%对9.8%，P = 0.036），且更常接受保守治疗（49.1%对30.8%，P = 0.038），而男性吸烟的比例明显高于女性（30.8%对14%，P = 0.028），平均血清肌酐（1.2对0.8mg/dL；P = 0.022）和尿酸值（6.9对6.2mg/dL；P = 0.048）更高。在纳入的122例患者中，109例有症状记录。非典型表现的患病率为4.6%（95%CI 0.7 - 8.5%）。在我们的研究组中，UA患者有心血管缺血性疾病史的情况更常见（77.4%对56.7%，P = 0.015），NSTEMI患者的尿素氮平均值高于UA患者（47对39mg/dL，P = 0.038），与UA患者相比，NSTEMI患者更常接受介入治疗（60%对41.9%；P = 0.046）。