冠状动脉非阻塞性心肌梗死的临床特征分析

Analysis of clinical features in patients with myocardial infarction with non-obstructive coronary artery

目的分析冠状动脉非阻塞性心肌梗死(MINOCA)及冠状动脉阻塞性心肌梗死(MIOCA)患者的临床特征。方法随机入选2017年1月~2019年1月于武汉大学人民医院住院的急性心肌梗死患者445例,根据冠脉造影结果分为MINOCA组(89例)和MIOCA组(356例),比较两组一般资料、主诉症状特点、心电图表现等。结果两组年龄、性别、冠心病史、肌钙蛋白I、肌酸激酶同工酶、肌红蛋白、氨基末端脑钠肽前体、左室射血分数、高密度脂蛋白胆固醇比较,差异有统计学意义(P<0.05)。两组体重指数、高血压史、糖尿病史、高脂血症史、吸烟史、家族史、三酰甘油、总胆固醇、低密度脂蛋白胆固醇、游离脂肪酸、空腹血糖、肌酐比较,差异无统计学意义(P>0.05)。MINOCA组胸痛伴放射痛发生率低于MIOCA组,含服硝酸甘油有效率高于MIOCA组,差异有统计学意义(P<0.05)。两组胸闷、胸痛、症状出现时间<3 d比较,差异无统计学意义(P>0.05)。MINOCA组正常、T波改变发生率低于MIOCA组,ST段抬高、病理性Q波形成、完全性左束支传导阻滞发生率高于MIOCA组,差异有统计学意义(P<0.05)。两组ST段压低≥0.05 mV、室性早搏、短阵室速、室性心动过速、室颤发生率比较,差异无统计学意义(P>0.05)。结论临床上,MINOCA心肌酶指标、心功能、胸痛症状、心电图表现均较MIOCA轻,且两者在高危因素上除年龄外,其余并无明显差异。

Objective To analyze the clinical features of myocardial infarction with non-obstructive coronary artery(MINOCA)and myocardial infarction with obstructive coronary artery(MIOCA).Methods A total of 445 patients with acute myocardial infarction admitted to Renmin Hospital of Wuhan University from January 2017 to January 2019 were randomly selected.According to the results of coronary angiography,they were divided into MINOCA group(89 cases)and MIOCA group(356 cases).The general data,the characteristics of the main complaints,and the electrocardiogram were compared between two groups.Results There were significant differences in age,sex,history of coronary heart disease,troponin I,creatine kinase isoenzyme,myoglobin,pro amino terminal brain natriuretic peptide,left ventricular ejection fraction and high-density lipoprotein cholesterol between two groups(P<0.05).There was no significant difference in BMI,hypertension,diabetes,hyperlipidemia,smoking,family history,triacylglycerol,total cholesterol,LDL cholesterol,free fatty acids,fasting blood glucose and creatinine between two groups(P>0.05).The incidence of chest pain and radiation pain in MINOCA group was lower than that in MIOCA group,and the effective rate of nitroglycerin in MINOCA group was higher than that in MIOCA group,the differences were statistically significant(P<0.05).There was no significant difference between two groups in occurrence time of chest distress,chest pain and symptoms<3 d(P>0.05).The incidence of normal and T wave changes in MINOCA group was lower than that in MIOCA group,and the incidence of ST segment elevation,pathological Q wave formation and complete left bundle branch block in MINOCA group was higher than that in MIOCA group,the differences were statistically significant(P<0.05).There was no significant difference between two groups in the incidence of ST segment depression≥0.05 mV,ventricular premature beat,short array ventricular tachycardia,ventricular tachycardia and ventricular fibrillation(P>0.05).Conclusion Clinically,MINOCA myocardial enzyme index,cardiac function,chest pain symptoms,and electrocardiogram performance are lighter than MIOCA,and there is no significant difference between two groups in terms of high risk factors except age.