Montenegro Sá Fernando, Ruivo Catarina, Santos Luís G, Antunes Alexandre, Saraiva Fátima, Soares Francisco, Morais João
Department of Cardiology, Centro Hospitalar de Leiria, Leiria, Portugal.
Coron Artery Dis. 2018 Sep;29(6):511-515. doi: 10.1097/MCA.0000000000000619.
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. We aim to determine MINOCA differential characteristics, the main etiologies, and prognostic outcomes.
We carried out a retrospective longitudinal analysis including 1047 patients with MI, from 1 January 2011 to 1 January 2016, subjected to coronary angiography and classified according to the presence [MI and obstructive coronary artery disease (MICAD)] or absence (MINOCA) of any coronary stenosis of at least 50%. Studied data included clinical, demographic, laboratorial, and angiographic features. The median follow-up duration was 35 (interquartile range: 25) months. Mortality was the primary endpoint. To identify MINOCA underlying etiologies, only the final diagnosis obtained according to the European Society of Cardiology proposed algorithm was accepted. To determine MINOCA predictors, multivariate analysis with logistic regression was carried out.
The mean age of the patients was 66.3±13.4 years; 319 (30.5%) patients were women. The MINOCA group included 114 (10.8%) patients. The underlying final diagnosis in the MINOCA group was obtained in 78 (68.4%) patients. The total mortality rate was 8.8% (n=10) in the MINOCA group versus 17.7% (n=165) in the MICAD group, P=0.018. After multivariate analysis, age [odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03-1.07, P<0.001], female sex (OR=3.91, 95% CI: 2.53-6.06, P<0.001), no previous tobacco use (OR=3.41, 95% CI: 1.68-3.90, P=0.001), atrial fibrillation (OR=3.62, 95% CI: 1.56-8.40, P=0.003), no previous AMI (OR=6.85, 95% CI: 1.65-28.5, P=0.008), and non-ST-segment elevation myocardial infarction diagnosis (OR=5.36, 95% CI: 2.62-10.96, P<0.001) remained independent predictors of MINOCA.
MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. Despite lower mortality than MICAD, the commonly attributed low-risk classification for MINOCA may be erroneous.
非阻塞性冠状动脉心肌梗死（MINOCA）是一种异质性疾病，在当代医学中常被忽视。我们旨在确定MINOCA的不同特征、主要病因及预后结果。
我们进行了一项回顾性纵向分析，纳入了2011年1月1日至2016年1月1日期间接受冠状动脉造影的1047例心肌梗死患者，并根据是否存在至少50%的冠状动脉狭窄分为有狭窄组[心肌梗死合并阻塞性冠状动脉疾病（MICAD）]和无狭窄组（MINOCA）。研究数据包括临床、人口统计学、实验室及血管造影特征。中位随访时间为35（四分位间距：25）个月。死亡率是主要终点。为确定MINOCA的潜在病因，仅接受根据欧洲心脏病学会提出的算法得出的最终诊断。为确定MINOCA的预测因素，进行了逻辑回归多变量分析。
患者的平均年龄为66.3±13.4岁；319例（30.5%）为女性。MINOCA组包括114例（10.8%）患者。MINOCA组中78例（68.4%）患者获得了最终诊断。MINOCA组的总死亡率为8.8%（n = 10），而MICAD组为17.7%（n = 165），P = 0.018。多变量分析后，年龄[比值比（OR）= 1.05，95%置信区间（CI）：1.03 - 1.07，P < 0.001]、女性（OR = 3.91，95% CI：2.53 - 6.06，P < 0.001）、既往无吸烟史（OR = 3.41，95% CI：1.68 - 3.90，P = 0.001）、心房颤动（OR = 3.62，95% CI：1.56 - 8.40，P = 0.003）、既往无急性心肌梗死史（OR = 6.85，95% CI：1.65 - 28.5，P = 0.008）及非ST段抬高型心肌梗死诊断（OR = 5.36，95% CI：2.62 - 10.96，P < 0.001）仍是MINOCA的独立预测因素。
MINOCA代表了一组具有挑战性的异质性患者，其临床特征与经典心血管危险因素不同。尽管MINOCA的死亡率低于MICAD，但通常认为其低风险的分类可能是错误的。
