非阻塞性冠状动脉心肌梗死患者的急性并发症：一项特别关注机械并发症的系统评价
Acute Complications in Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries: A Systematic Review with Special Focus on Mechanical Complications.
作者信息
Bil Jacek, Buller Patryk, Gil Robert J, Gromadziński Leszek, Onichimowski Dariusz, Jalali Rakesh, Kern Adam
机构信息
Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland.
Cardiology Clinic, Voivodeship Hospital, 09-400 Płock, Poland.
出版信息
Rev Cardiovasc Med. 2022 Dec 2;23(12):393. doi: 10.31083/j.rcm2312393. eCollection 2022 Dec.
BACKGROUND
Recently, we have observed an increasing focus on myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) patients. MINOCA incidence is estimated to be within the range of 5-15% of all MI cases. Unfortunately, MINOCA relates to various conditions that are not rarely hard to identify, including coronary microcirculation dysfunction, epicardial coronary spasm, or plaque erosion. Our systematic review aimed to identify and appraise previous studies which characterized acute complications, with particular focus on mechanical complications, in patients with MINOCA.
METHODS
Applying the MeSH strategy in PubMed and Embase, two operators independently and systematically reviewed published studies on patients diagnosed with MINOCA and in whom acute complications were described. Papers published in the last 10 years (June 2012-June 2022) to reflect the introduction of the MINOCA definition as well as the current clinical practice were analyzed. The research was conducted in July 2022.
RESULTS
The search yielded 192 records. After abstract review, 79 papers were left, and after full-text analysis, we finally included 20 studies. Among 20 studies, there were: one randomized controlled trial, one prospective study, five retrospective studies, 1 case series, and 12 case reports with a total number of 337,385 patients. In the identified literature, we revealed 7 cases of intraventricular septal rupture, 3 cases of free wall rupture with pericardial effusion or cardiac tamponade, and 3 cases of bleeding complications (intracerebral or intestinal bleeding). Moreover, the ventricular arrhythmia incidence ranged from 2% to 13.8%, and the in-hospital death rate ranged from 0.9% to 6.4%.
CONCLUSIONS
These findings suggest that MINOCA patients should be treated as standard MI patients with watchful monitoring, especially in the first few days.
背景
最近，我们注意到对非阻塞性冠状动脉心肌梗死（MINOCA）患者的关注日益增加。据估计，MINOCA的发病率在所有心肌梗死病例的5%-15%范围内。不幸的是，MINOCA与各种情况相关，这些情况往往很难识别，包括冠状动脉微循环功能障碍、心外膜冠状动脉痉挛或斑块侵蚀。我们的系统评价旨在识别和评估先前关于MINOCA患者急性并发症（尤其关注机械并发症）的研究。
方法
在PubMed和Embase中应用医学主题词（MeSH）策略，两名操作人员独立且系统地回顾了已发表的关于诊断为MINOCA且描述了急性并发症的患者的研究。分析了过去10年（2012年6月至2022年6月）发表的论文，以反映MINOCA定义的引入以及当前的临床实践。该研究于2022年7月进行。
结果
检索共获得192条记录。经过摘要审查，剩余79篇论文，经过全文分析，我们最终纳入了20项研究。在这20项研究中，有1项随机对照试验、1项前瞻性研究、5项回顾性研究、1个病例系列和12篇病例报告，患者总数为337385例。在已识别的文献中，我们发现了7例室间隔破裂、3例游离壁破裂伴心包积液或心脏压塞以及3例出血并发症（脑出血或肠出血）。此外，室性心律失常的发生率在2%至13.8%之间，住院死亡率在0.9%至6.4%之间。
结论
这些发现表明，MINOCA患者应作为标准心肌梗死患者进行密切监测治疗，尤其是在最初几天。
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