Patterns of coronary artery ectasia and short-term outcome in acute myocardial infarction
Patterns of coronary artery ectasia and short-term outcome in acute myocardial infarction
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DOI：
10.3109/14017431.2014.902495
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发表时间：
2014-06-01
影响因子：
2.2
通讯作者：
Henein, Michael Y.
中科院分区：
文献类型：
--
作者：
Boles, Usama;Zhao, Ying;Henein, Michael Y.
客观的。评估急性心肌梗死 (AMI) 和冠状动脉扩张 (CAE) 患者的血液学炎症体征、心血管危险 (CV) 因素和预后之间的关系。设计。我们调查了 2009 年 1 月至 2012 年 8 月期间在英国两个中心需要紧急初级经皮介入治疗的 3321 名 AMI 患者。将 30 名 CAE 患者与 60 名年龄和性别匹配的对照患者进行了比较。胸痛发作后 2 小时内采集血液。根据记录评估心血管风险因素。记录了 2 年多的主要急性心脏事件和/或死亡 (MACE)。结果。 CAE 的发生率为 2.7%，且更常影响右动脉 (RCA) (p = 0.001) 和左回旋动脉 (LCx) (0.0001)。在非 CAE 患者中，罪魁祸首病变更常与动脉粥样硬化相关 (p = 0.001)。然而，心血管危险因素未能在各组之间进行区分，但糖尿病除外，糖尿病在 CAE 中的发生率较低 (p = 0.02)。与非 CAE 患者相比，CAE 患者的 CRP 较高（p = 0.006），而白细胞总数、中性粒细胞计数和中性粒细胞/淋巴细胞比（N/L 比）较低（分别为 p = 0.002、0.002 和 0.032）。弥漫性 CAE 与局部 CAE 的情况也是如此（分别为 p = 0.02、0.008 和 0.03）。 CAE 和非 CAE 患者的 MACE 发生率没有差异 (p = 0.083)，并且临床管理和 MACE 与炎症标志物无关。结论。在 AMI 中，CAE 患者的 RCA 和 LCx 常有动脉瘤样改变，其炎症反应与非 CAE 患者不同。这些差异不具有预后相关性，也不表明需要采取不同的治疗方法。
Objective. To assess the relationship between hematological inflammatory signs, cardiovascular risk (CV) factors and prognosis in patients presenting with acute myocardial infarction (AMI) and coronary artery ectasia (CAE). Design. We investigated 3321 AMI patients who required urgent primary percutaneous intervention in two centres in the United Kingdom between January 2009 and August 2012. Thirty patients with CAE were compared with 60 age-and gender-matched controls. Blood was collected within 2 h of the onset of chest pain. CV risk factors were assessed from the records. Major acute cardiac events and/or mortality (MACE) over 2 years were documented. Results. CAE occurred in 2.7% and more often affected the right (RCA) (p = 0.001) and left circumflex artery (LCx) (0.0001). Culprit lesions were more frequently related to atherosclerosis in non-CAE patients (p = 0.001). Yet, CV risk factors failed to differentiate between the groups, except diabetes, which was less frequent in CAE (p = 0.02). CRP was higher in CAE (p = 0.006), whereas total leucocyte, neutrophil counts and neutrophil/lymphocyte ratio (N/L ratio) were lower (p = 0.002, 0.002 and 0.032, respectively) than among non-CAE. This also was the case in diffuse versus localised CAE (p = 0.02, 0.008 and 0.03, respectively). The MACE incidence did not differ between CAE and non-CAE (p = 0.083) patients, and clinical management and MACE were unrelated to the inflammatory markers. Conclusion. In AMI, patients with CAE commonly have aneurysmal changes in RCA and LCx, and their inflammatory responses differ from those with non-CAE. These differences did not have prognostic relevance, and do not suggest different management.