心脏磁共振评估非梗阻冠状动脉心肌梗死预后的研究

A Study on the Prognosis of Nonobstructive Coronar Artery Myocardial Infarction Evaluated by Cardiac Magnetic Resonance Imaging

目的 探讨心血管磁共振(CMR)对冠状动脉非梗阻心肌梗死(MINOCA)患者预后的评价价值。方法 对388名接受心脏磁共振(CMR)评估的MINOCA患者进行分析,并对其主要临床终点进行前瞻性追踪。结果 74%的心肌炎、心肌梗死和心肌病患者CMR能够确定肌钙蛋白升高的原因,而正常CMR的确诊率为26%。5.7%的患者死亡,心肌病组预后最差(病死率15%,P<0.001),心肌炎组和正常心肌病组的病死率分别为4%和2%。在多变量COX回归模型中(包括临床和CMR参数),心肌病的CMR诊断和心电图ST段抬高仍然是唯一两个有意义的死亡率预测因素。以心电图ST段抬高和心肌梗死诊断为危险指标,0、1和2个因素的死亡风险率分别为2%、11%和21%(P<0.0.001)。结论 MINOCA患者中,CMR(发病后37天的中位数)在74%的患者中确定了最终诊断。心肌病病死率最高,其次是心肌梗塞。死亡率的最强预测因素是心肌病的CMR诊断和心电图ST段抬高。

Objective To explore the impact of cardiovascular magnetic resonance(CMR) on the prognosis of patients with non obstructive myocardial infarction(MINOCA) in coronary arte ries.Methods An analysis was conducted on 388 MINOCA patients who underwent cardiac magnetic resonance(CMR) evaluation,and their primary clinical endpoints we re prospectively tra cked.Results Among74% of patients(myocarditis,myocardial infarction,and cardiomyopathy),CMR(median 37 days)was able to determine the cause of elevated troponin,while the diagnostic rate of normal CMR was 26%.On average follow-up of 1262 days(3.5 years),5.7% of patients died.The prognosis of the cardiomyopathy group was the worst(mortality rate of 15%;pairwise test:19.9;P<0.001),while the mortality rates of the myocarditis group and the normal cardiomyopathy group were 4% and 2%,respectively.In multivariate COX regression models(including clinical and CMR parameters),CMR diagnosis of cardiomyopathy and ST segment elevation on electrocardiogram remain the only two meaningful predicto rs of mortality.Using electrocardiogram ST segment elevation and myocardial infa rction diagnosis as risk indicators,the mortality risk rates for 0,1,and 2 factors were 2%,11%,and21%,respectively(P<0.001).Conclusion Among MINOCA patients,CMR(median 37 days after onset)was determined as the final diagnosis in 74% of patients.The mortality rate of ca rdiomyopathy is the highest,followed by myoca rdial infarction.The strongest predictors of mortality are CMR diagnosis of ca rdiomyopathy and ST segment elevation on electrocardiogram.