抗磷脂综合征患者急性心肌梗死的不同亚型及预后
The distinct subtypes and prognosis of acute myocardial infarction in antiphospholipid syndrome patients.
作者信息
Huang Can, Zhao Yuan, Jiang Hui, Zhou Yangzhong, Hu Chaojun, Guo Xiaoxiao, Li Mengtao, Zeng Xiaofeng, Zhao Jiuliang
机构信息
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, Beijing, China.
出版信息
Clin Rheumatol. 2025 Aug 18. doi: 10.1007/s10067-025-07624-4.
INTRODUCTION
Acute myocardial infarction (AMI) can be divided into myocardial infarction with coronary artery disease (MICAD) or with nonobstructive coronary arteries (MINOCA) according to the severity of artery stenosis. Antiphospholipid syndrome (APS) can present with AMI, but the subtype and prognosis are not fully understood.
METHODS
The study was conducted based on the APS cohort in Peking Union Medical College Hospital. According to coronary angiography, AMI patients were classified as MICAD or MINOCA. Thrombotic APS (tAPS) patients were enrolled to explore the risk factors of AMI.
RESULTS
The study enrolled 36 APS-AMI patients, 26 (72%) patients with MICAD and 10 (28%) with MINOCA. 345 tAPS patients without coronary artery disease in APS cohort were selected as a control group. The risk factors of AMI were male, smoking history, anti-cardiolipin antibody (aCL), and anti-β2 glycoprotein I antibody (aβ2GPI). Secondary APS and aCL were more common in MINOCA (70% VS. 23.1%, P = 0.018; 100% (10/10) VS. 65.4%, P = 0.039), while previous atherosclerotic cardiovascular disease was less common in MINOCA (0 VS. 50%, P = 0.006). MINOCA patients tended to receive immunosuppression and anticoagulation therapy, while 57.7% MICAD patients received revascularization. In total, 13 (36.1%) patients experienced AMI recurrence during a mean follow-up of 42.25 months, which only occurred in the MICAD group. Over 60% (8/13) had recurrence more than once. Hydroxychloroquine was found to be a possible protective factor for AMI recurrence (HR 0.106, P = 0.032).
CONCLUSION
Male, smoking history, aCL, and aβ2GPI can be risk factors for AMI in APS patients. APS-MINOCA group had a significantly better prognosis. Hydroxychloroquine might prevent AMI recurrence. Key Points • Acute myocardial infarction (AMI) patients with antiphospholipid syndrome (APS) were younger than typical AMI patients, and 45% were women. • The subtype, myocardial infarction with non-obstructive coronary arteries (MINOCA) and myocardial infarction with coronary artery disease (MICAD), and prognosis of AMI in APS patients remains unknown. • MINOCA was associated with secondary APS and aCL, while MICAD with previous ASCVD. • MINOCA had a significantly better prognosis. Hydroxychloroquine might prevent AMI relapse.
引言
急性心肌梗死（AMI）可根据动脉狭窄程度分为冠状动脉疾病所致心肌梗死（MICAD）或非阻塞性冠状动脉所致心肌梗死（MINOCA）。抗磷脂综合征（APS）可表现为AMI，但对其亚型和预后尚未完全了解。
方法
本研究基于北京协和医院的APS队列进行。根据冠状动脉造影，将AMI患者分为MICAD或MINOCA。纳入血栓性APS（tAPS）患者以探讨AMI的危险因素。
结果
本研究纳入36例APS-AMI患者，其中26例（72%）为MICAD，10例（28%）为MINOCA。选取APS队列中345例无冠状动脉疾病的tAPS患者作为对照组。AMI的危险因素为男性、吸烟史、抗心磷脂抗体（aCL）和抗β2糖蛋白I抗体（aβ2GPI）。继发性APS和aCL在MINOCA中更常见（70%对23.1%，P = 0.018；100%（10/10）对65.4%，P = 0.039），而既往动脉粥样硬化性心血管疾病在MINOCA中较少见（0对50%，P = 0.006）。MINOCA患者倾向于接受免疫抑制和抗凝治疗，而57.7%的MICAD患者接受血运重建治疗。总共13例（36.1%）患者在平均42.25个月的随访期间发生AMI复发，且仅发生在MICAD组。超过60%（8/13）的患者复发不止一次。发现羟氯喹可能是AMI复发的一个保护因素（HR 0.106，P = 0.03）。
结论
男性、吸烟史、aCL和aβ2GPI可能是APS患者发生AMI的危险因素。APS-MINOCA组预后明显更好。羟氯喹可能预防AMI复发。要点 • 抗磷脂综合征（APS）合并急性心肌梗死（AMI）的患者比典型AMI患者年轻，且45%为女性。 • APS患者AMI的亚型，即非阻塞性冠状动脉所致心肌梗死（MINOCA）和冠状动脉疾病所致心肌梗死（MICAD）及其预后仍不清楚。 • MINOCA与继发性APS和aCL相关，而MICAD与既往动脉粥样硬化性心血管疾病相关。 • MINOCA预后明显更好。羟氯喹可能预防AMI复发。
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