Department of Cardiology.
CAPITAL Research Group.
Coron Artery Dis. 2021 Jan;32(1):10-16. doi: 10.1097/MCA.0000000000000903.
Clinical characteristics and outcomes of patients diagnosed with myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) remain largely unknown. Furthermore, we do not yet understand if women with MINOCA have worse outcomes similar to what has historically been observed with MI. The aims of the current study were to evaluate the (1) incidence of MINOCA in patients presenting with MI, (2) compare in-hospital outcomes of MINOCA and obstructive atherosclerotic coronary artery disease MI (OACD-MI), and (3) comparison of in-hospital clinical outcomes of patients with MINOCA stratified by sex.
In this observational study, we combined data from two large university hospitals from Canada and Australia. Clinical characteristics and in-hospital outcomes of MINOCA and OACD-MI were analyzed by matching these patients in a 1:1 ratio after selecting patients with OACD-MI by systematic random sampling. Clinical characteristics associated with MINOCA were identified through multivariate logistic regression. Primary outcome of interest was net adverse cardiovascular events (NACE) defined as death, heart failure, stroke, and major bleeding. The incidence rate of MINOCA was 9.5%. Women, absence of traditional cardiac risk factors, and absence of ST-deviations on ECG were associated with diagnosis of MINOCA on angiography. NACE (P = 0.0001), death (P = 0.019), stroke (P = 0.002), and heart failure (P = 0.001) were significantly lower in patients with MINOCA. Subgroup analysis of women and men diagnosed with MINOCA revealed similar in-hospital outcomes.
The incidence of MINOCA was 9.5%. Compared to OACD-MI, patients with MINOCA have less cardiac risk factors. In-hospital outcomes of patients diagnosed with MINOCA were better than OACD-MI.
患有非阻塞性冠状动脉疾病（MINOCA）的心肌梗死（MI）患者的临床特征和结局在很大程度上仍不清楚。此外，我们还不知道女性 MINOCA 是否与历史上观察到的 MI 一样存在预后更差的情况。本研究的目的是评估：（1）MI 患者中 MINOCA 的发病率；（2）MINOCA 和阻塞性动脉粥样硬化性冠状动脉疾病 MI（OACD-MI）患者的住院期间结局；（3）MINOCA 患者住院期间临床结局的性别分层比较。
在这项观察性研究中，我们合并了来自加拿大和澳大利亚两所大型大学医院的数据。通过系统随机抽样选择 OACD-MI 患者后，对 MINOCA 和 OACD-MI 患者进行 1:1 匹配，以分析 MINOCA 和 OACD-MI 的临床特征和住院期间结局。通过多变量逻辑回归确定与 MINOCA 相关的临床特征。主要研究终点是净不良心血管事件（NACE），定义为死亡、心力衰竭、卒中和主要出血。MINOCA 的发生率为 9.5%。女性、缺乏传统心脏危险因素和心电图无 ST 偏移与血管造影诊断 MINOCA 相关。MINOCA 患者的 NACE（P=0.0001）、死亡（P=0.019）、卒中和心力衰竭（P=0.002 和 P=0.001）发生率显著降低。对女性和男性诊断为 MINOCA 的患者进行亚组分析，结果显示其住院期间结局相似。
MINOCA 的发生率为 9.5%。与 OACD-MI 相比，MINOCA 患者的心脏危险因素较少。诊断为 MINOCA 的患者的住院期间结局优于 OACD-MI。
