无心血管危险因素的非ST段抬高型心肌梗死的特征及院内结局研究

Characteristics and in-hospital outcomes of non-ST-segment elevation myocardial infarction patients without standard modifiable cardiovascular risk factors

目的比较未合并传统心血管危险因素(standard modifiable cardiovascular risk factors,SMuRF)患者和合并SMuRF患者的特征和院内结局,探索导致差异的因素。方法纳入2017年1月至2022年12月年首都医科大学宣武医院收治的非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者,收集临床资料。SMuRF指以下任一种危险因素:高血压、糖尿病、高脂血症或吸烟。未合并SMuRF的患者也被称为“SMuRF-less”患者。使用logistic回归模型分析SMuR-less和SMuRF患者的结局差异。结果共纳入1211例患者,中位年龄为64岁,女性占24.5%,SMuRF-less患者占7.3%。相较SMuRF群体,SMuRF-less群体的体重指数更低,较少合并冠心病病史,左主干病变比例更高。SMuRF-less组的病情严重程度、再灌注治疗率、院内主要不良心血管事件发生率(28.4%比33.8%,P=0.299)均与SMuRF组相似。多因素校正后,两组的院内主要不良心血管事件风险仍无差异(OR=0.83,95%CI 0.43~1.62)。结论在NSTEMI患者中,SMuRF-less群体约占1/5,其左主干病变比例较高。SMuRF-less与SMuRF患者在诊疗及院内结局方面无明显差异。其在病因和病理生理方面是否有差异有待进一步探索。

Objective To compare the differences in characteristics and in-hospital outcomes between the non-ST-segment elevation myocardial infarction(NSTEMI)patients with and without standard modifiable cardiovascular risk factors(SMuRF)and explore the accounting factors to explain these differences.Methods 1211 patients with NSTEMI admitted to Xuanwu Hospital of Capital Medical University from January 2017 to December 2022 were included.SMuRF refers to any of the following risk factors:hypertension,diabetes,hyperlipidemia and smoking.The patients without SMuRF were also called“SMuRF-less”patients.Logistic regression models were used to compare the in-hospital outcomes between the patients with and without SMuRF.Results Among the patients(median age 64 years,24.5%women),7.3%were SMuRF-less.Compared with the patients with SMuRF,the SMURF-less group had a lower body mass index,less history of coronary heart disease and a higher proportion of left main lesions.There were no differences in the clinical conditions,the use of reperfusion and the rate of major adverse cardiovascular events(28.4%vs.33.8%,P=0.299)between the two groups.After multivariable adjustment,the risk of major adverse cardiovascular events between the 2 groups remained similar(OR=0.83,95%CI 0.43~1.62).Conclusion About one in ten patients with NSTEMI have no SMuRF,who have a higher proportion of left main lesions.There is no differences in treatment and in-hospital outcomes between the SMuRF and SMuRF-less patient.Whether there are differences in the etiology and pathophysiology remains to be determined.