2018 年第 12 期 第 13 卷

急性心肌梗死合并肥厚型心肌病患者临床特征和远期预后及危险因素分析

Clinical characteristics, long-term outcomes and risk factors of acute myocardial infarction complicated with hypertrophic cardiomyopathy

作者：马越刘放张黛刘妍张敬林王德广彭文龙程宇婧赵奇周玉杰

英文作者：

单位：100029首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所冠心病精准治疗北京市重点实验室首都医科大学冠心病临床诊疗与研究中心

英文单位：

关键词：急性心肌梗死；肥厚型心肌病；远期预后

英文关键词：

• 摘要：

• 【摘要】目的    分析急性心肌梗死（AMI）合并肥厚型心肌病（HCM）患者的临床特征、远期预后及相关危险因素。方法    连续入选2005年7月至2017年10月在首都医科大学附属北京安贞医院就诊的HCM合并AMI的成年患者78例，按照性别、年龄和入院日期以1∶1的比例匹配单纯AMI组及单纯HCM组，对患者的临床资料进行回顾性分析，包括临床特征、冠状动脉造影检查结果及血运重建情况等。研究终点为主要不良心血管事件（MACE）和其他次要终点事件。结果    HCM合并AMI组左心室射血分数和室间隔厚度均大于单纯AMI组，但均小于单纯HCM组（均P＜0.01），LVEF＜40%患者比例明显低于其他2组（P＝0.001）。平均随访（4.8±2.9）年，HCM合并AMI组发生MACE患者19例（27.9%），单纯AMI组11例（16.7%），单纯HCM组8例（12.3%）。HCM合并AMI组的远期预后更差，MACE（Log-rank P＝0.030）和次要终点事件（Log-rank P＝0.032）发生率均高于其他2组。COX风险比例模型分析显示，远期MACE的危险因素为陈旧性心肌梗死（风险比＝5.873，95%置信区间：1.449～23.807，P＝0.013）、心力衰竭（风险比＝10.990，95%置信区间：2.651～45.570，P＝0.001）和冠状动脉累及数目（风险比＝86.343，95%置信区间：4.138～1 801.415，P＝0.004）。结论    与单纯HCM及单纯AMI患者相比，HCM合并AMI患者的心血管危险因素较多，远期预后较差。陈旧性心肌梗死和心力衰竭对于AMI患者远期MACE的发生有预测价值，而HCM疾病本身不是MACE的危险因素。

• 【Abstract】Objective    To analyze the clinical characteristics, long-term outcomes and risk factors of acute myocardial infarction（AMI） complicated with hypertrophic cardiomyopathy(HCM). Methods    A retrospective study was conducted at Beijing Anzhen Hospital, Capital Medical University from July 2005 to October 2017, including 78 consecutive patients with HCM and AMI (HCM＋AMI group), 78 patients with AMI without HCM(AMI group) and 78 patients with HCM without AMI(HCM group). Clinical features, coronary angiography Results and therapeutic strategies were analyzed. Endpoint events included major adverse cardiac events(MACEs) and other secondary endpoints. Results    Left ventricular ejection fraction and interventricular septal thickness in the HCM＋AMI group were higher than those in the AMI group but lower than those in the HCM group（P＜0.01）. Ratio of patients with LVEF＜40% in the HCM＋AMI group was lower than that in other two groups（P＝0.001）. During a follow-up period of (4.8±2.9)years, MACEs occurred in 19 patients(27.9%) in the HCM＋AMI group, in 11 patients(16.7%) in the AMI group and in 8 patients(12.3%) in the HCM group. Incidences of MACE（Log-rank P＝0.030） and secondary endpoints（Log-rank P＝0.032） in the HCM＋AMI group were higher than those in other two groups. COX proportional hazard regression model showed that old myocardial infarction（hazard ratio＝5.873， 95% confidence interval： 1.449-23.807， P＝0.013）, heart failure（hazard ratio＝10.990， 95% confidence interval： 2.651-45.570， P＝0.001） and the number of coronary lesions (hazard ratio=86.343, 95% confidence interval: 4.138-1 801.415, P=0.004) were risk factors of long-term MACE. Conclusions    AMI with HCM patients have high cardiovascular risk and poor long-term outcome. Old myocardial infarction and heart failure are predictors of MACE in AMI patients; the comorbidity of HCM shows no predictive value for cardiovascular outcomes.