| Background In 1959,Prinzmetal et al.observed a type of angina pectoris with transient ST-segment elevation in the resting state,which was later confirmed as "Variant angina pectoris（VAP）",which is a typical coronary spasm.angina pectoris.Coronary spasm refers to the reversible complete or incomplete occlusion of the main subepicardial coronary artery and its branches spontaneously or under certain incentives,resulting in interruption of blood flow in the blood supply area of ??the spasm,causing myocardial ischemia,The electrocardiogram showed transient ST-segment elevation or depression and symptoms of angina.Due to the differences in the location,degree and duration of coronary spasm,the symptoms caused by coronary spasm also manifest in different types,including VAP,atypical vasospastic angina,acute myocardial infarction（AMI）,Sudden death,arrhythmia,and silent myocardial ischemia are collectively referred to as Coronary Artery Spasm Syndrome（CASS）.Coronary spasm is also the leading cause of myocardial infarction with no obstructive coronary atherosclerosis（MINOCA）,accounting for about 38%.At present,the exact pathophysiological mechanism of coronary spasm is still unclear,but it is the result of the joint action of many factors.The onset of coronary spasm is uncertain and unpredictable.VAP will recur after myocardial infarction caused by coronary spasm,causing panic to patients and affecting the quality of life.Postinfarction angina（PIA）refers to the recurrence of angina symptoms within 1 month after myocardial infarction.The appearance of PIA often predicts a poor clinical prognosis,suggesting the possibility of recurrent myocardial infarction,arrhythmia and even sudden death.Objective The clinical data of patients with acute myocardial infarction caused by coronary spasm were retrospectively analyzed,and the related influencing factors of VAP recurrence within1 month after myocardial infarction caused by coronary spasm were investigated,so as to provide a clinical basis for reducing the occurrence of this phenomenon.Methods A total of 459 patients with coronary spasm and angina pectoris were collected from the "Variant Angina Pectoris Research Database" of Henan Provincial People’s Hospital Heart Center Fuwai Huazhong Cardiovascular Hospital from June 1980 to January 2022.,including 45 patients with myocardial infarction due to coronary spasm.The clinical data of 45 patients were collected,including gender,age,smoking history,drinking history,diabetes history,hypertension history,disease course,duration of symptom onset,coronary artery disease,spastic target vessel distribution,myocardial infarction site,stent The history of implantation and the time from the first onset of VAP to the onset of myocardial infarction,the site of recurrent VAP,and the clinical classification of symptoms at the time of recurrent VAP in the recurrent VAP group.According to whether VAP recurred after AMI,the patients were divided into two groups: recurrent VAP group（16 cases）and non-recurrent VAP group（29 cases）.To analyze the influencing factors of recurrent VAP in patients with myocardial infarction caused by coronary spasm.Results一.Univariate Analysis1.The incidence of AMI caused by coronary spasm and the incidence of recurrent VAP within 1 month after AMI Among the 459 patients with coronary spasm,45 patients had AMI,and the incidence rate was 9.8%.Among them,16 patients developed variant angina pectoris within 1 month after AMI,and the incidence rate was 35.6%.2.Comparison of general clinical data Compared with the non-VAP group,the recurrence rate of VAP group was higher（93.8%vs.55.2%,P<0.05）.There were no significant differences in gender,age,drinking history,hypertension history,and diabetes history between the two groups of patients.3.Incidence comparison Compared with the non-VAP group,the recurrence VAP group had statistically significant differences between the onset forms,the degree of coronary artery disease,and the course of disease（P < 0.05）.There was no significant difference between the two groups in the duration of time and whether the onset of symptoms was accompanied by arrhythmia.4.Treatment situation There was no significant difference in stent implantation history after percutaneous coronary intervention（PCI）after acute myocardial infarction（P>0.05）.5.The recurrence of the recurrence of VAP group The time of recurrence of angina pectoris in 16 patients was the earliest on the 1st day after acute myocardial infarction and the latest was on the 21 st day after acute myocardial infarction,of which 7（43.75%）patients occurred on the 2nd day after acute myocardial infarction;15（93.8%）patients The recurrence site of angina pectoris was the original myocardial infarction site;when the symptoms recurred,15 cases（87.5%）were clinically classified as common type.二.Multivariate Analysis Smoking history,simple variant of seizure form and disease duration > 1 month were independent risk factors for recurrence of VAP within 1 month after coronary spasm-induced AMI,and the odds ratios（OR）were 11.628（95% CI=1.035-130.586）,respectively.,P=0.047),9.427（95% CI=1.280-69.434,P=0.028）,10.375（95%CI=1.373-78.380,P=0.023）.Conclusion The incidence of acute myocardial infarction caused by coronary spasm was 9.8%,and the incidence of recurrent VAP within 1 month after acute myocardial infarction was35.6%.The occurrence time of VAP after myocardial infarction caused by coronary spasm is 1-21 days after myocardial infarction,and the most common is on the second day.Smoking,simple variant of seizure form and disease duration > 1 month were independent risk factors for VAP after myocardial infarction caused by coronary spasm. |
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