背景:家族性高胆固醇血症(FH)增加了早期动脉粥样硬化疾病的倾向。在因急性心肌损伤(AMI)入院的FH患者中,对住院结局的了解有限。
目的:我们的研究旨在确定心肌损伤类型,包括1型心肌梗死(MI),2型MI和Takotsubo心肌病,评估FH合并AMI患者的病变严重程度并研究短期住院不良结局。
方法:我们的研究回顾性查询了2018年至2020年的美国国家住院患者样本。
方法:成人入院时患有AMI,并根据FH的存在进行分类。
结果:我们评估了心肌损伤类型和冠状动脉血运重建的复杂性。研究了全因死亡率的主要结局和其他临床次要结局。
结果:有3711765例AMI入院,其中2360例(0.06%)患有FH。FH与ST段抬高型MI(STEMI)(校正OR(aOR):1.62,p<0.001)和非ST段抬高型MI(NSTEMI)(aOR:1.29,p<0.001)的几率较高相关,但较低的2型MI(aOR:0.39,p<0.001)和takotsubo心肌病(aOR:0.36,p=0.004)。FH与更高的多支架经皮冠状动脉介入治疗相关(aOR:2.36,p<0.001),多支血管冠状动脉搭桥术(aOR:2.65,p<0.001),心内血栓(aOR:3.28,p=0.038)和机械循环支持(aOR:1.79,p<0.001)的几率更高.全因死亡率的几率降低了50%(aOR:0.50,p=0.006),机械通气的几率降低了50%(aOR:0.37,p<0.001)。室性心动过速的发生率没有差异,心脏复律,新的植入式心律转复除颤器植入,心源性休克和心脏骤停。
结论:在AMI住院患者中,FH与较高的STEMI和NSTEMI相关,下2型MI和Takotsubo心肌病,多个支架和冠状动脉旁路的数量增加,和机械循环支持装置,但与全因死亡率和机械通气率较低相关。
BACKGROUND: Familial hypercholesterolaemia (FH) increases propensity for premature atherosclerotic disease. Knowledge of inpatient outcomes among patients with FH admitted with acute myocardial injury (AMI) is limited.
OBJECTIVE: Our
study aimed to identify myocardial injury types, including type 1 myocardial infarction (MI), type 2 MI and takotsubo
cardiomyopathy, assess lesion severity and
study adverse short-term inpatient outcomes among patients with FH admitted with AMI.
METHODS: Our
study retrospectively queried the US National Inpatient Sample from 2018 to 2020.
METHODS: Adults admitted with AMI and dichotomised based on the presence of FH.
RESULTS: We evaluated myocardial injury types and complexity of coronary revascularisation. Primary outcome of all-cause mortality and other clinical secondary outcomes were studied.
RESULTS: There were 3 711 765 admissions with AMI including 2360 (0.06%) with FH. FH was associated with higher odds of ST-elevation MI (STEMI) (adjusted OR (aOR): 1.62, p<0.001) and non-ST-elevation MI (NSTEMI) (aOR: 1.29, p<0.001) but lower type 2 MI (aOR: 0.39, p<0.001) and takotsubo
cardiomyopathy (aOR: 0.36, p=0.004). FH was associated with higher multistent percutaneous coronary interventions (aOR: 2.36, p<0.001), multivessel coronary artery bypass (aOR: 2.65, p<0.001), higher odds of intracardiac thrombus (aOR: 3.28, p=0.038) and mechanical circulatory support (aOR: 1.79, p<0.001). There was 50% reduction in odds of all-cause mortality (aOR: 0.50, p=0.006) and lower odds of mechanical ventilation (aOR: 0.37, p<0.001). There was no difference in rate of ventricular tachycardia, cardioversion, new implantable cardioverter defibrillator implantation, cardiogenic shock and cardiac arrest.
CONCLUSIONS: Among patients hospitalised with AMI, FH was associated with higher STEMI and NSTEMI, lower type 2 MI and takotsubo
cardiomyopathy, higher number of multiple stents and coronary bypasses, and mechanical circulatory support device but was associated with lower all-cause mortality and rate of mechanical ventilation.