Особенности клиники и менеджмента у больных с инфарктом миокарда без обструктивного поражения коронарных артерий
DOI:
https://doi.org/10.52692/1857-0011.2024.1-78.07Ключевые слова:
инфаркт миокарда без подъема сегмента ST, инфаркт миокарда без обструктивного поражения коронарных артерийАннотация
Цель: Оценка частоты инфаркта миокарда без подъема сегмента ST и без обструктивного поражения коронарных артерий (NSTE-MINOCA) и сравнительный анализ клинических и лечебных данных при инфаркте миокарда без подъема сегмента ST с обструктивными коронарными артериями (NSTEMI-CAD). Материал и методы. В исследование включены 494 пациента с диагнозом NSTEMI. Больные были разделены на 2 группы в зависимости от наличия обструкции коронарных артерий: I группа - 35 пациентов с MINOCA и II группа - 459 MI-CAD. Результаты. Частота MINOCA в исследуемой группе NSTEMI составила 7,08%. Факторы риска сердечно- сосудистых заболеваний у пациентов с MINOCA регистрируются реже, чем в группе MI-CAD. Маркеры некроза миокарда имели повышенный уровень при MI-CAD по сравнению с MINOCA: тропонин - 8,58±0,89 vs 2,8±1,3, КФК-МВ 20,7±1,78 vs 13,97±2,6 нг/л, р<0,05 и высокочувствительный тропонин - 767,4 vs 8248 нг. /л, р<0,001. С-реактивный белок имел более высокий уровень у больных с MINOCA (36,62±16,27) по сравнению с MI-CAD (22,16±2,39), р<0,05. Что касается лечения, исследование показало, что пациенты с MINOCA по сравнению с MI- CAD принимали реже двойную антиагрегантную терапию (28,6 vs 89,2%), статинов (45,7 vs 83,1%) и иАПФ /АРА (90,4 vs 57,1%), р<0,001). Выводы: Частота MINOCA-NSTEMI составила 7,08%. Пациенты MINOCA имеют более низкий уровень факторов риска. При MINOCA наблюдаются более низкие значения маркеров некроза миокарда и повышенные значения маркеров воспаления по сравнению с MI-CAD.
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