Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Cardiology Department, Counties Manukau District Health Board, Auckland, New Zealand.
Heart. 2019 Apr;105(7):524-530. doi: 10.1136/heartjnl-2018-313665. Epub 2018 Sep 29.
The medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).
We performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome-Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.
Of the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.
MINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.
非阻塞性冠状动脉心肌梗死（MINOCA）患者的中期预后和死亡原因尚不清楚。本研究旨在比较阻塞性冠状动脉疾病（CAD）和 MINOCA 后心肌梗死（MI）患者的死亡率和再发事件率，并与无心血管疾病（CVD）的年龄和性别匹配队列进行比较。
我们对 2013 年至 2015 年期间连续 2 年在全新西兰急性冠状动脉综合征质量改进（ANZACS QI）登记处接受 MI 冠状动脉造影的患者进行了全国性队列研究。MI 患者登记数据与国家住院和死亡率记录匿名链接。无已知 CVD 的年龄和性别匹配患者构成对照组。
在 8305 例 MI 患者中，897 例（10.8%）被归类为 MINOCA。与无已知 CVD 的患者相比，主要结局（全因死亡或复发性非致命性 MI）的调整 HR 分别为阻塞性 CAD 患者 7.81（95%CI 6.64 至 9.19，p<0.0001）和 MINOCA 患者 4.64（95%CI 3.54 至 6.10，p<0.0001）。2 年时，阻塞性 CAD 患者的 Kaplan-Meier 全因死亡率为 7.9%，其中近一半为 CVD 死亡（分别为 3.6%的 CVD 死亡和 4.5%的非 CVD 死亡）。相比之下，MINOCA 的全因死亡率为 4.9%，非 CVD 死亡（4.5%）为主。
MINOCA 很常见，其不良预后发生率约为阻塞性 CAD 患者的一半。死亡的主要原因是非 CVD 死亡。MINOCA 的事件发生率明显高于无 CVD 的人群。
