背景:在没有阻塞性冠状动脉(MINOCA)并伴有左心室动脉瘤的情况下,对既往心肌梗死患者的治疗方法进行了研究。我们的研究旨在说明这种独特实体的临床特征并报告中期手术结果。
方法:研究了10例MINOCA合并左心室室壁瘤患者。根据美国心脏协会的科学声明诊断了MINOCA。左心室重建的适应症如下:明确的证据表明有动脉瘤和运动异常的左心室,有心肌梗死史,伴有心力衰竭症状。心绞痛,或者室性心律失常.主要不良心脑血管事件(MACCE),包括死亡,心肌梗塞,卒中被认为是主要终点.
结果:整个研究人群的中位随访时间为64.5个月。七名MINOCA患者在4年内发展为左心室动脉瘤,三名MINOCA患者在首次入院时被发现伴有左动脉瘤。手术前,没有患者服用血管紧张素转换酶抑制剂.他汀类药物,双重抗血小板治疗,2、5和5例患者服用β受体阻滞剂,分别。手术后,随访中未发生MACCE。在随访中,射血分数(EF)显着增加(p=0.0009)。
结论:在MINOCA患者发生左心室动脉瘤之前,需要密切监测和标准的药物治疗。对于患有左心室动脉瘤的MINOCA患者,左心室重建仍然是可行的选择,在这一独特实体中,中期结果令人满意。
BACKGROUND: There is a paucity of studies examining the treatment of patients with prior myocardial infarction in the absence of obstructive coronary arteries (MINOCA) and with a concomitant left ventricular aneurysm. Our
study aims to illustrate the clinical characteristics and report the mid-term surgical outcomes in this distinct entity.
METHODS: Ten patients with MINOCA and left ventricular aneurysm were investigated. The MINOCA was diagnosed according to Scientific Statement from the American Heart Association. The indication for left ventricular reconstruction was as follows: clear evidence of both an aneurysmal and akinetic left ventricle with a history of myocardial infarction accompanied by heart failure symptoms, angina, or ventricular arrhythmias. Major adverse cardiovascular and cerebrovascular events (MACCE), including death, myocardial infarction, stroke was considered the primary endpoints.
RESULTS: The median follow-up for the whole
study population was 64.5 months. Seven MINOCA patients developed a left ventricular aneurysm within 4 years and three MINOCA patients were found to have a concomitant left aneurysm at the first admission. Before surgery, no patients were prescribed angiotensin-converting enzyme inhibitors. Statins, dual antiplatelet therapy, and β-blockers were prescribed in 2, 5, and 5 patients, respectively. After surgery, no MACCE occurred in the follow-up. There was a significant increase in ejection fraction (EF) in the follow-up (p = 0.0009).
CONCLUSIONS: Close monitoring and standard medical treatment are required before a left ventricular aneurysm occurs in MINOCA patients. Left ventricular reconstruction remains a viable option for MINOCA patients with left ventricular aneurysms and mid-term outcomes were satisfying in this distinct entity.