摘要
目的:比较中国有典型胸痛和无典型胸痛的急性ST段抬高型心肌梗死(STEMI)患者的临床和冠状动脉(冠脉)病变特征及预后情况。方法:中国急性心肌梗死(CAMI)注册研究自2013-01-01至2014-09-30共入选26 591例急性心肌梗死患者,其中12 145例为STEMI并接受冠脉造影检查。典型胸痛定义为剧烈而持久(持续时间超过20 min)的胸骨后或心前区压榨性疼痛,休息或含服硝酸甘油不能缓解。结果:2 922例STEMI(24.1%)患者无典型胸痛。与典型胸痛患者相比,无典型胸痛患者较多合并糖尿病(20.0%vs 17.8%),从发病到医院时间>12小时的比例较高(35.2%vs 23.9%),罪犯血管为左前降支者比例较低(44.6%vs51.2%),而为右冠脉的比例较高(42.9%vs 36.9%);无典型胸痛患者急诊经皮冠脉介入治疗(PCI)比例较低(64.9%vs73.9%),住院期间死亡率较高(3.3%vs 2.2%),以上差异均有统计学意义(P均<0.05)。多变量Logistic回归分析表明,无典型胸痛是患者住院期间死亡的独立危险因素(比值比=1.364,95%可信区间:1.018~1.827)。结论:约四分之一的STEMI患者就诊时无典型胸痛症状。无典型胸痛患者就诊时间晚,接受急诊PCI的比例低,住院期间死亡率较高,临床应加强对无典型胸痛STEMI患者的识别和治疗。
Objectives： To explore the clinical and coronary disease characteristics and prognosis of Chinese patients with ST segment elevation myocardial infarction and without typical chest pain.Methods： By extracting data from China Acute Myocardial Infarction Registry, we included 12 145 STEMI patients who underwent coronary angiography between 01 January 2013 to 30 September 2014. Variables of interest were extracted and compared between AMI patients without vs with typical chest pain. Multivariable logistic regression analysis was used to identify independent predictors of in-hospital mortality.Results： There were approximately 24%（2 922/12 145） STEMI patients without typical chest pain. Compared with typical chest pain patients, patients without typical chest pain had higher prevalence of diabetes（20.0% vs 17.8%）, longer time of disease onset to hospital, lower rate of IRA disease of left anterior descending artery（44.6% vs 51.2%）. These patients were less likely to receive primary percutaneous coronary intervention（64.9% vs 73.9%） and had higher in-hospital mortality（3.3% vs 2.2%, P〈0.05）. Multivarite Logistic regression analysis indicated atypical chest pain was an independent risk factor for in-hospital death（OR： 1.364, 95% confidence interval： 1.018-1.827）.Conclusions： Approximately a quarter STEMI patients presented without typical chest pain in this patient cohort and they had longer disease onset to hospital time, were less likely to receive PCI, and associated with higher in-hospital mortality risk. Efforts should be made to identify these patients in order to apply the optimal treatments to them.
作者
伏蕊
宋晨曦
杨进刚
许海燕
高晓津
李卫
窦克非
杨跃进
FU Rui;SONG Chen-xi;YANG Jin-gang;XU Hai-yan;GAO Xiaoojin;LI Wei;DOU Ke-fei;YANG Yue-jin(Behalf of China Acute Myocardial Infarction （CAMI） Registry Research Grou;Coronary Heart Disease Center, National Center for Cardiovascular Diseases and Fuwai Hospital, CAMS and PUMC, Beijing （100037）, Chin)
出处
《中国循环杂志》
CSCD
北大核心
2018年第6期524-528,共5页
Chinese Circulation Journal
基金
国家“十二·五”科技支撑计划课题(2011BAI11B02)
国家卫生和计划生育委员会公益性行业科研专项(201402001)
中国医学科学院医学与健康科技创新工程(2016-I2M-1-009)
关键词
心肌梗死
无典型胸痛
冠状动脉造影
院内死亡率
Myocardial infarction
Atypical chest pain
Coronary angiography
In-hospital mortality
