Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Am J Med. 2019 Mar;132(3):335-346. doi: 10.1016/j.amjmed.2018.10.007. Epub 2018 Oct 25.
Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.
In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.
The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P = .54).
About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD.
非阻塞性冠状动脉心肌梗死（MINOCA）较为常见。MINOCA 患者再梗死的机制和预后数据有限。
在这项观察性研究中，纳入了 2003 年 7 月至 2013 年 6 月期间在瑞典登记于 SWEDEHEART 登记处的 MINOCA 住院患者，随访至 2013 年 12 月，总共纳入了 199163 例心肌梗死患者中的 9092 名独特的 MINOCA 患者。因复发性 MI 住院的 570 名（6.3%）MINOCA 患者构成了研究组。
患者平均年龄为 69.1 岁，59.1%为女性。中位再入院时间为 17 个月。共有 340 名患者接受了新的冠状动脉造影检查，其中 180 名（53%）无阻塞性冠状动脉疾病（CAD），160 名（47%）有阻塞性 CAD；123 名患者为单支血管病变，26 名患者为双支血管病变，9 名患者为三支血管病变，2 名患者合并左主干和单支血管病变。与复发性 MINOCA 患者相比，有阻塞性 CAD 的 MI 患者中男性、糖尿病、外周血管疾病、肌酐水平较高和入院时 ST 段抬高更为常见。在中位随访 38 个月期间，无论再梗死事件是 MINOCA 还是 MI 合并阻塞性 CAD，死亡率均相似，分别为 13.9%和 11.9%（P=0.54）。
大约一半接受冠状动脉造影检查的 MINOCA 后再梗死患者的冠状动脉狭窄程度进展。MINOCA 后发生心肌梗死的患者应强烈考虑进行血管造影检查。复发性事件相关的死亡率很高，但在有或无明显 CAD 的患者之间，死亡率没有差异。
