Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Int J Cardiol. 2018 Jun 15;261:18-23. doi: 10.1016/j.ijcard.2018.03.056. Epub 2018 Mar 14.
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCAs) is an increasingly recognized entity. No previous study has evaluated predictors for new major adverse cardiacvascular events (MACEs) and death in patients with MINOCA.
We conducted an observational study of MINOCA patients recorded between July 2003 and June 2013 and followed until December 2013 for outcome events. Out of 199,163 MI admissions, 9092 consecutive unique patients with MINOCA were identified. The mean age was 65.5 years and 62% were women. MACE was defined as all-cause mortality, rehospitalization for acute MI, ischemic stroke and heart failure. Hazard ratio and 95% confidence interval (HR; 95% CI) was calculated using Cox-regression.
A total of 2147 patients (24%) experienced a new MACE and 1254 patients (14%) died during the mean follow-up of 4.5 years. Independent predictors for MACE after adjustment, were older age (1.05; 1.04-1.06), diabetes (1.44; 1.21-1.70), hypertension (1.25; 1.09-1.43), current smoking (1.38; 1.15-1.66), previous myocardial infarction (1.38; 1.04-2.82), previous stroke (1.69; 1.35-2.11), peripheral vascular disease (1.55; 1.97-2.23), chronic obstructive pulmonary disease (1.63; 1.32-2.00), reduced left ventricular ejection fraction (2.00; 1.54-2.60), lower level of total cholesterol (0.88; 0.83-0.94) and higher level of creatinine (1.01; 1.00-1.03). Independent predictors for all cause death were age, current smoking, diabetes, cancer, chronic obstructive pulmonary disease, previous stroke, reduced left ventricular fraction, lower level of total cholesterol and higher levels of creatinine and CRP.
The clinical factors predicting new MACE and death of MINOCA patients seem to be strikingly similar to factors previously shown to predict new cardiovascular events in patients with MI and obstructive coronary artery disease.
非阻塞性冠状动脉心肌梗死（MINOCAs）是一种越来越被认识到的病症。以前没有研究评估过 MINOCA 患者新发主要不良心血管事件（MACEs）和死亡的预测因素。
我们对 2003 年 7 月至 2013 年 6 月期间记录的 MINOCA 患者进行了一项观察性研究，并随访至 2013 年 12 月，以评估结局事件。在 199163 例心肌梗死住院患者中，确定了 9092 例连续的 MINOCA 患者。平均年龄为 65.5 岁，62%为女性。MACE 定义为全因死亡率、因急性 MI 再次住院、缺血性卒中和心力衰竭。使用 Cox 回归计算危险比和 95%置信区间（HR；95%CI）。
在平均 4.5 年的随访中，共有 2147 例（24%）患者发生新的 MACE，1254 例（14%）患者死亡。多因素调整后，新发 MACE 的独立预测因素包括年龄较大（1.05；1.04-1.06）、糖尿病（1.44；1.21-1.70）、高血压（1.25；1.09-1.43）、当前吸烟（1.38；1.15-1.66）、既往心肌梗死（1.38；1.04-2.82）、既往卒中等（1.69；1.35-2.11）、外周血管疾病（1.55；1.97-2.23）、慢性阻塞性肺疾病（1.63；1.32-2.00）、左心室射血分数降低（2.00；1.54-2.60）、总胆固醇水平较低（0.88；0.83-0.94）和肌酐水平较高（1.01；1.00-1.03）。全因死亡的独立预测因素包括年龄、当前吸烟、糖尿病、癌症、慢性阻塞性肺疾病、既往卒中等、左心室射血分数降低、总胆固醇水平降低、肌酐和 CRP 水平升高。
MINOCA 患者新发 MACE 和死亡的临床预测因素似乎与以前预测 MI 和阻塞性冠状动脉疾病患者新发心血管事件的因素非常相似。
