PARTICULARITĂȚI CLINICE ȘI DE MANAGEMENT ALE PACIENȚILOR CU INFARCT MIOCARDIC FĂRĂ SUPRADENIVELAREA SEGMENTULUI ST CU ARTERE CORONARE NON-OBSTRUCTIVE
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.07Cuvinte cheie:
инфаркт миокарда без подъема сегмента ST, инфаркт миокарда без обструктивного поражения коронарных артерийRezumat
Scop: Aprecierea ratei infarctului miocardic fără elevarea segmentului ST cu artere coronare non-obstructive (NSTE- MINOCA) și analiza comparativă a datelor clinice și de management cu infarctul miocardic fără elevarea segmentului ST cu artere coronare obstructive (NSTEMI-CAD). Material și metode: În studiu au fost incluși 494 pacienți cu diagnosticul de infarct miocardic fără supradenivelarea segmentului ST (NSTEMI). Pacienții au fost repartizați în 2 loturi de cercetare în funcție de prezența obstrucției pe arterele coronare: lotul I - 35 de pacienți cu infarct miocardic cu artere coronare non-obstructive (MINOCA) și lotul II - 459 de pacienți cu infarct miocardic cu artere coronare obstructive (MI-CAD). Rezultate: Rata MINOCA în lotul NSTEMI studiat a fost de 7.08%. Ponderea factorilor de risc: fumat, diabet zaharat (DZ), HTA a fost mai mare în lotul MI-CAD vs MINOCA. Markerii necrozei miocardice au avut valori crescute în MI- CAD vs MINOCA: troponina cantitativă - 8.58±0.89 vs 2.8 ±1.3, CK-MB 20.7 ±1.78 vs 13.97±2.6 ng/L, p<0.05 și troponina înalt sensibilă - 767.4 vs 8248 ng/L, p<0.001. Totodată, proteina C reactivă (PCR) a avut un nivel mai crescut la pacienții cu MINOCA (36.62 ±16.27) vs MI-CAD (22.16±2.39), p<0.05. Din particularitățile de tratament studiul a scos în evidență că pacienților cu NSTE-MINOCA comparativ cu NSTEMI-CAD li se indică într-o măsură mai mică dubla terapie antiplachetară (28.6 vs 89.2%), statine (45.7 vs 83.1%) și IEC/BRA (90.4 vs 57.1 %), p<0.001). Concluzii: Rata NSTE-MINOCA a fost de 7,08%. Pacienții cu MINOCA au o pondere mai redusă a factorilor de risc. În MINOCA se înregistrează valori mai mici ale markerilor necrozei miocardice și valori crescute ale markerilor inflamației comparativ cu MI-CAD.
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