冠状动脉非阻塞性心肌梗死临床特征分析

Analysis of clinical features of myocardial infarction with non-obstructive coronary atherosclerosis

目的分析冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特征。方法回顾性分析北部战区总医院2019年3-8月收治的39例MINOCA患者的相关资料,对患者的临床特征进行总结。结果1537例急性心肌梗死患者中,共有MINOCA患者39例,MINOCA发生率为2.5%;39例患者中,男性28例,女性11例;平均年龄(55.79±11.12岁);冠状动脉造影示冠状动脉心肌桥4例;非ST段抬高型心肌梗死29例,ST段抬高型心肌梗死10例;应激性心肌病1例;14例患者入监护室治疗,38例给予阿司匹林联合氢氯吡格雷或替格瑞洛双联抗血小板治疗,25例给予血管紧张素转化酶抑制剂/血管紧张素Ⅱ受体阻滞剂,29例给予β受体阻滞剂,39例给予他汀类药物治疗,3例给予抗凝治疗,1例植入双腔除颤永久起搏器;治疗后,1例心脏破裂,3例充血性心力衰竭,2例恶性心律失常,2例死亡。结论MINOCA是多种潜在病因导致的临床综合征,病因不同,患者预后也不同。优化精准的个体化治疗及管理方案可提高该病的诊疗水平,改善患者预后。

Objective To analyze the clinical characteristics of patients with coronary artery non-obstructive myocardial infarction(MINOCA).Methods A retrospective study was performed on 39 cases who were diagnosed MINOCA and admitted from March to August 2019.The clinical characteristics of the patients were summarized.Results Among the 1537 patients with acute myocardial infarction,there were 39 patients with MINOCA,and the incidence of MINOCA was 2.5%.Among the 39 patients,males were 28 and females were 11.Mean age was(55.79±11.12)years old.Coronary angiography showed myocardial bridge of coronary artery in 4 cases.There were 29 cases of non-ST-segment elevation myocardial infarction and 10 cases of ST-segment elevation myocardial infarction.One case was stress cardiomyopathy.The 14 patients into the standard treatment,38 cases were given aspirin combined clopidogrel hydrogen or for Greg los dual antiplatelet therapy,25 cases to angiotensin converting enzyme inhibitor/angiotensinⅡreceptor blockers,29 cases were given beta blockers,39 cases were given statins treatment,3 cases of anticoagulant therapy,1 case of double cavity defibrillation permanently implanted pacemaker.After treatment,1 case of heart rupture,3 cases of congestive heart failure,2 cases of malignant arrhythmias and 2 cases of deaths were reported.Conclusion MINOCA is a clinical syndrome caused by a variety of underlying causes.Patients with different etiologies had different prognosis.Optimization of precise individualized treatment and management plan can improve the diagnosis and treatment level of the disease and improve the prognosis of patients.