不同心电图表现冠状动脉非阻塞性心肌梗死患者临床特征分析

Analysis of clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries in different ECG manifestations

目的探讨不同心电图表现下,冠状动脉(简称冠脉)非阻塞性心肌梗死(myocardial infarction with non-obstructive coronary arteries,MINOCA)患者的临床特征。方法从行冠脉造影的急性心肌梗死患者中选取符合MINOCA诊断的患者361例,按照心电图表现是ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)还是非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI),将其分为STEMI组(n=84)和NSTEMI组(n=277)。回顾性分析两组患者的一般临床资料、实验室检查结果及冠脉造影结果。结果与STEMI组相比,NSTEMI组平均发病年龄更大,女性及高血压、糖尿病患者占比均更高;STEMI组有吸烟史者占比更高,上述差异均有统计学意义(均P<0.05)。STEMI组白细胞计数、中性粒细胞计数、血小板计数均高于NSTEMI组,且差异有统计学意义(P<0.05)。血小板分布宽度、左心室射血分数以NSTEMI组更高,且差异有统计学意义(P<0.05)。STEMI组病因以斑块破裂、冠脉痉挛、血栓形成比例更高,NSTEMI组病因则以氧供失衡、不明病因比例更高,且差异有统计学意义(P<0.05)。结论MINOCA患者心电图改变以NSTEMI多见。与心电图表现为STEMI的MINOCA患者相比,NSTEMI组患者的发病年龄更大,女性更多见,临床危险因素占比更高,炎症指标及血小板指标更低,病因以氧供失衡、不明病因比例更高。

Objective To investigate the clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries(MINOCA) in different ECG manifestations.Methods We selected 361 patients diagnosed with MINOCA from those with acute myocardial infarction undergoing coronary angiography.According to ECG manifestations of ST-segment elevation myocardial infarction(STEMI) or non-ST-segment elevation myocardial infarction(NSTEMI),they were divided into STEMI group(n=84) and NSTEMI group(n=277).The general clinical data,laboratory examination results and coronary angiography results of the two groups were retrospectively analyzed.Results Compared with the STEMI group,the mean age of disease onset was greater in the NSTEMI group,while the proportion of females,and patients with hypertension and diabetes were all higher;the proportion of cases with smoking history was higher in the STEMI group,all with statistically significant differences(all P<0.05).The white blood cell count,neutrophil count,and platelet count in the STEMI group were all higher than those in the NSTEMI group,and the differences were statistically significant(P<0.05).Platelet distribution width and left ventricular ejection fraction were higher in the NSTEMI group with statistically significant differences(P<0.05).Plaque rupture,coronary spasm and thrombosis accounted for the majority of the disease causes in the STEMI group while the proportion of disease causes of oxygen supply imbalance and unknown etiology were higher in the NSTEMI group with statistically significant differences(P<0.05).Conclusion NSTEMI was the most common ECG change in MINOCA patients.Compared with MINOCA patients with ECG manifestations of STEMI,patients in the NSTEMI group had a greater age of disease onset,and more females are in the group,while these patients had a higher proportion of clinical risk factors,lower inflammatory and platelet indicators,and oxygen supply imbalance and unknown etiology account for higher proportion of disease causes.