Institute of Cardiology, Jagiellonian University Medical College, Kopernika 17 Street, 31-501, Kraków, Poland.
2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
J Thromb Thrombolysis. 2019 Apr;47(3):462-466. doi: 10.1007/s11239-018-1794-z.
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is an important clinical problem especially in the era of extensive utilization of coronary angiography in MI patients. Its pathophysiology is poorly understood which makes diagnostics and treatment of MINOCA challenging in everyday clinical practice. The aim of the study was to assess characteristics of MINOCA patients in Poland based on data from the Polish National ORPKI Registry. In 2016, 49,893 patients with non-ST-segment elevation (NSTEMI) or ST-segment elevation (STEMI) myocardial infarction entered the ORPKI registry. MINOCA was defined as a non-obstructive coronary artery disease (CAD) and a lack of previous coronary revascularization. MINOCA was identified in 3924 (7.8%) patients and clinical presentation was more often NSTEMI than STEMI (MINOCA: 78 vs. 22%; obstructive CAD 51.1 vs. 48.9%; p < 0.0001). MINOCA patients were younger and more often females with significantly lower rates of diabetes, smoking, arterial hypertension, kidney disease, previous MI and previous stroke comparing to patients with obstructive CAD. Myocardial bridge was visualized in angiography more often in the MINOCA group (2.2 vs. 0.4%; p < 0.0001). Additional coronary assessment inducing fractional flow reserve, intravascular ultrasound, optical coherence tomography was marginally (< 1%) used in both groups. Periprocedural mortality was lower in MINOCA group (0.13% vs. 0.95%; p < 0.0001). MINOCA patients represent a significant proportion of MI patients in Poland. Due to multiple potential causes, MINOCA should be considered rather as a working diagnosis after coronary angiography and further efforts should be taken to define the cause of MI in each individual patient.
非阻塞性冠状动脉心肌梗死（MINOCA）是一个重要的临床问题，尤其是在广泛应用冠状动脉造影的时代，其病理生理学尚未完全了解，这使得 MINOCA 的诊断和治疗在日常临床实践中具有挑战性。本研究的目的是基于波兰国家 ORPKI 登记处的数据，评估波兰 MINOCA 患者的特征。2016 年，49893 例非 ST 段抬高（NSTEMI）或 ST 段抬高（STEMI）心肌梗死患者进入 ORPKI 登记处。MINOCA 定义为非阻塞性冠状动脉疾病（CAD）和缺乏先前的冠状动脉血运重建。MINOCA 患者有 3924 例（7.8%），临床表现多为 NSTEMI 而非 STEMI（MINOCA：78%比 22%；阻塞性 CAD：51.1%比 48.9%；p<0.0001）。MINOCA 患者更年轻，女性更多，糖尿病、吸烟、动脉高血压、肾脏疾病、既往心肌梗死和既往中风的发生率明显低于阻塞性 CAD 患者。MINOCA 组的血管造影中更常观察到心肌桥（2.2%比 0.4%；p<0.0001）。两组均很少使用（<1%）血流储备分数、血管内超声、光学相干断层扫描等额外的冠状动脉评估。MINOCA 组围手术期死亡率较低（0.13%比 0.95%；p<0.0001）。MINOCA 患者在波兰的 MI 患者中占相当大的比例。由于多种潜在原因，MINOCA 应被视为冠状动脉造影后的诊断，应进一步努力确定每个患者 MI 的原因。
