| Objective: The aim of this study was to analyze and compare the clinical characteristics among acute myocarditis suspected myocardial infarction, myocarditis non-suspected myocardial infarction and acute myocardial infarction(AMI), and then to discuss the effect of coronary angiography on the diagnosis and prognosis of myocarditis.Methods: We retrospectively analyzed patients who were admitted in our hospital from January 2012 to June 2015 and were definitely diagnosed as acute myocarditis. According to undergoing coronary angiography(CAG) or not, they were assigned to CAG-group or non-CAG-group. AMI-group patients were collected to match with myocarditis-group patients for age and sex according to the proportion of 1:1. All these patients’ clinical datum were compared among these groups, including gender, age, medical history, symptom, sign and examine.Results: 1.One hundred and forty patients were retrospectively collected with acute myocarditis. Out of them, thirty eight patients(24.2%) underwent coronary angiography(CAG-group). Eighty patients were in AMI-group, for young patients could not be matched. 2.Compared with non-CAG group, CAG-group were older(27 vs 43.5 years old,P=0.000), and had more cardiovascular risk factors. The ratios of patients with two cardiovascular risk factors had significant differences(6.9% vs 21.1%,P=0.35) between two groups. In addition, values of cardiac troponin were higher in CAG-group(6.624 ng/ml vs 1.012ng/ml,P=0.005). Other factors such as gender, symptoms, sign, values of white blood cells and biochemical indicators, electrocardiogram, and echocardiography had no significant statistic differences. 3. Compared myocarditis-group with AMI-group: Clinical history: AMI-group were much older(34 vs 47 years old,P=0.000),and had more cardiovascular risk factors(P<0.05). Patients in AMI-group were more likely to have chest pain(19.3% vs 73.8%,P=0.000),more likely to have sudden onset of symptoms(22.14% vs 87.5%), and less likely to have previous infection(80% vs 11.3%,P=0.000). More patients in AMI-group tended to have radiating pain in left hands or shoulders(3.6% vs 27.5%,P=0.000). When patients suffered chest pain, sudden onset of symptoms and radiating pain, they could be diagnosed as AMI with specificity of 100%. The combination of previous infection and persistent symptoms could be used for diagnosis of myocarditis with specificity of 97.5%. Laboratory text: The myocarditis-group had higher values of ALT(42.5U/L vs 33U/L,P=0.021), NT-pro BNP(2240pg/ml vs 535.5pg/ml, P=0.000), procalcitonin(0.54ug/L vs 0.09ug/L,P=0.019) and CRP(15.05mg/L vs 3.65mg/L,P=0.001). When values of ALT were more than 150U/L, NT-pro BNP more than 10000pg/ml or CRP more than 100mg/L, myocarditis could be diagnosed with specificity over 90%. Examine: In myocarditis-group, most electrocardiogram changes had no leads selectivity and echocardiography showed diffuse wall motion abnormality, while in AMI-group, most electrocardiogram changes had leads selectivity and echocardiography showed segmental ventricular wall motion abnormality. 4. Compared CAG-group with the AMI-group which were matched with CAG-group, values of ALT more than 150U/L, NT-pro BNP more than 10000pg/ml or CRP more than 100mg/L also had high specificity for the diagnosis of myocarditis suspected MI.5. Compared with AMI-group, patients with myocarditis had high risks undergoing CAG, but there was no significant difference(P=0.102,P=0.085). Whether all myocarditis patients or patients with severe myocarditis, CAG did not increase their in-hospital mortality rate(P=0.529, P=0.296).Conclusions: Specific symptoms, significantly high index(ALT>150U/L, NT-pro BNP>10000pg/ml, CRP>100mg/L), electrocardiogram, echocardiography and CAG can help to distinguish myocarditis from AMI. CAG does not increase in-hospital mortality rate of myocarditis. |
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