From Discipline of Medicine, University of Adelaide, South Australia (S.P., R.P.D., R.T., J.F.B.); Cardiology Department, Queen Elizabeth Hospital, Adelaide, South Australia (S.P., R.P.D., R.T., J.F.B.); Discipline of Psychiatry, University of Adelaide, South Australia (T.A.); Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT (R.P.D.); Department of Internal Medicine, Yale School of Medicine, New Haven, CT (R.P.D.); and Cardiology Department, Lyell McEwin Hospital, Adelaide, South Australia (J.F.B.).
Circulation. 2015 Mar 10;131(10):861-70. doi: 10.1161/CIRCULATIONAHA.114.011201. Epub 2015 Jan 13.
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a puzzling clinical entity with no previous evaluation of the literature. This systematic review aims to (1) quantify the prevalence, risk factors, and 12-month prognosis in patients with MINOCA, and (2) evaluate potential pathophysiological mechanisms underlying this disorder.
Quantitative assessment of 28 publications using a meta-analytic approach evaluated the prevalence, clinical features, and prognosis of MINOCA. The prevalence of MINOCA was 6% [95% confidence interval, 5%-7%] with a median patient age of 55 years (95% confidence interval, 51-59 years) and 40% women. However, in comparison with those with myocardial infarction associated with obstructive coronary artery disease, the patients with MINOCA were more likely to be younger and female but less likely to have hyperlipidemia, although other cardiovascular risk factors were similar. All-cause mortality at 12 months was lower in MINOCA (4.7%; 95% confidence interval, 2.6%-6.9%) compared with myocardial infarction associated with obstructive coronary artery disease (6.7%, 95% confidence interval, 4.3%-9.0%). Qualitative assessment of 46 publications evaluating the underlying pathophysiology responsible for MINOCA revealed the presence of a typical myocardial infarct on cardiac magnetic resonance imaging in only 24% of patients, with myocarditis occurring in 33% and no significant abnormality in 26%. Coronary artery spasm was inducible in 27% of MINOCA patients, and thrombophilia disorders were detected in 14%.
MINOCA should be considered as a working diagnosis with multiple potential causes that require evaluation so that directed therapies may improve its guarded prognosis.
非阻塞性冠状动脉心肌梗死（MINOCA）是一种令人费解的临床实体，之前尚未对其文献进行评估。本系统评价旨在：（1）量化 MINOCA 患者的患病率、危险因素和 12 个月预后；（2）评估该疾病潜在的病理生理机制。
采用荟萃分析方法对 28 篇文献进行定量评估，评估 MINOCA 的患病率、临床特征和预后。MINOCA 的患病率为 6%（95%置信区间，5%-7%），中位患者年龄为 55 岁（95%置信区间，51-59 岁），女性占 40%。然而，与与阻塞性冠状动脉疾病相关的心肌梗死相比，MINOCA 患者更年轻、女性更多，但血脂异常更少，尽管其他心血管危险因素相似。MINOCA 患者 12 个月的全因死亡率为 4.7%（95%置信区间，2.6%-6.9%），低于与阻塞性冠状动脉疾病相关的心肌梗死（6.7%，95%置信区间，4.3%-9.0%）。对评估 MINOCA 潜在病理生理学的 46 篇文献进行定性评估发现，只有 24%的患者心脏磁共振成像上存在典型心肌梗死，33%的患者存在心肌炎，26%的患者无明显异常。MINOCA 患者中有 27%可诱导冠状动脉痉挛，14%发现血栓形成倾向障碍。
MINOCA 应被视为一种具有多种潜在病因的待查诊断，需要进行评估，以便针对性治疗可能改善其预后。
