冠状动脉非阻塞性心肌梗死患者的 1 年预后及预后影响因素分析

摘要

74 were females (46 .5%).The prevalence of non—ST—segment elevation myocardial infarction (NSTEMI) was higher than of ST—segment elevation myocardial infarction (STEMI ) (57 .9% vs.42 .1%, P＝ 0.007 ) in patients with MINOCA .None coronary artery stenosis was observed in 82 cases(51.6%) ,stenosis＜50% in 77 cases(48 .4%).The proportion of patients using secondary preventive drugs in hospital was low .Except for calcium channel blockers (CCB) ,the use of these drugs declined within one year follow—up (all P＜0.05).A total of 27 patients (19 .4%) had MACE : five patients (3.6%) had cardiovascular death ; three (2 .2%) suffered heart failure and 19(13.7%) developed cardiovascular—related rehospitalization.There was no nonfatal AMI occurred .The logistic regression model showed that age≥60 years ,lower level of total cholesterol (TC) and reduced left ventricular ejection fraction (LVEF) were significant predictors of MACE . Conclusions :The one—year prognosis of MINOCA patients is not optimistic .Age≥60 years ,lower level of TC and LVEF are independent risk factors for MACE in patients with MINOCA .%目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的1年预后及预后影响因素. 方法:收集2014年4月至2017年11月符合急性心肌梗死(AM I)诊断且冠状动脉造影检查显示冠状动脉非阻塞(狭窄＜50%)的MINOCA患者.分析患者的临床特征、治疗策略、随访1年主要不良心血管事件(M ACE )的发生率和预后影响因素.结果:2 660例AM I患者中159例诊断为MINOCA ,患病率为6 .0%. M INOCA平均年龄为(62 .7 ± 12 .9)岁,女性74例(46 .5%) ,非ST段抬高型心肌梗死(NSTEMI)多于ST段抬高型心肌梗死(ST EM I )(57 .9% 对42 .1%,P＝ 0 .007 ) ,冠状动脉无狭窄者82 例(51 .6%) ,存在狭窄病变(＜50%)者77例(48 .4%) . MINOCA 患者入院期间使用传统二级预防治疗药物的比例偏低,随访1年时,除钙离子拮抗剂(CCB )类药物,其他药物使用比例均明显下降( P均＜0 .05) . 1年随访中 M INOCA 患者发生 M ACE 27 例(19 . 4%) ,其中心源性死亡5例(3 .6%) ,心力衰竭3例(2 .2%) ,因心血管事件再住院19例(13 .7%) ,无非致命性再发心肌梗死发生. Logistic回归分析显示,M ACE的独立预测因子是年龄≥60岁、低总胆固醇(TC )水平和低左室射血分数(LVEF ) . 结论:中国MINOCA患者1年预后情况不乐观,年龄≥60岁、低 TC和低LVEF是M ACE的独立危险因素.