在ST细分段的死亡率升高 带有非阻塞性冠状动脉和模仿者的心肌梗塞
Odayme Quesada1,2, Mehmet Yildiz2, Timothy D Henry2
1Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio.
JAMA network open
|November 16, 2023
概括
患有ST段升高心肌梗塞 (STEMI) 和非阻塞性冠状动脉心肌梗塞 (MINOCA) 的患者面临更高的死亡风险. 这项研究发现,与阻塞性冠状动脉疾病相比,MINOCA与增加的死亡率有关,而MINOCA模仿者显示出类似的风险.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 公共卫生 公共卫生
背景情况:
- 对于患有非阻塞性冠状动脉 (MINOCA) 的ST段升高心肌梗塞 (STEMI) 患者的预后尚不清楚.
- 了解MINOCA,MINOCA模仿者和阻塞性冠状动脉疾病之间的结果差异对于患者管理至关重要.
研究的目的:
- 为了比较因MINOCA,MINOCA模仿者和阻塞性冠状动脉疾病而出现STEMI的患者的5年死亡率.
- 确定这些STEMI子组内临床特征和预后的潜在差异.
主要方法:
- 一项基于注册的前性队列研究的回顾性分析,涉及三个中西部STEMI计划连续的STEMI激活.
- 患者被分为MINOCA,MINOCA模仿者 (例如,takotsubo心肌病变,心肌炎) 或基于冠状动脉血管造影和托波水平的阻塞性疾病.
- 用调整的考克斯回归分析来评估5年死亡风险.
主要成果:
- 该研究包括8560名STEMI患者:95.2%是阻塞性疾病,1.4%是MINOCA,3.8%是MINOCA模仿者.
- 在5年的随访中,阻塞性疾病的死亡率为16%,MINOCA为18%,MINOCA模仿剂为18%.
- 调整后的分析显示,与阻塞性疾病相比,MINOCA的5年死亡风险高1.93倍,而MINOCA模仿者没有显著差异.
结论:
- 与阻塞性冠状动脉疾病患者相比,患有MINOCA的STEMI患者的死亡风险明显更高.
- 对于MINOCA模仿者的死亡风险与阻塞性冠状动脉疾病的死亡风险相似.
- 需要进一步的研究来阐明MINOCA高风险种群中潜在的病理生理机制.
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