Vranken Nousjka P A, Pustjens Tobias F S, Kolkman Evelien, Hermanides Renicus S, Bekkers Sebastiaan C A M, Smulders Martijn W, van Cauteren Yvonne J M, Heijman Jordi, Rasoul Saman, Ottervanger Jan P, van 't Hof Arnoud W J
Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
Department of Cardiology, Zuyderland Medical Centre, Heerlen, the Netherlands.
Int J Cardiol Heart Vasc. 2020 Jul 1;29:100572. doi: 10.1016/j.ijcha.2020.100572. eCollection 2020 Aug.
Whether patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) have better outcomes than patients with obstructive coronary artery disease remains contradictory. The current study focussed on the clinical profile and prognosis of MINOCA patients.
We performed a retrospective analysis of patients with acute coronary syndrome (ACS) admitted to the Isala hospital in Zwolle, the Netherlands, between 2006 and 2014. A total of 7693 patients were categorized into three groups: MINOCA, single-vessel obstructive ACS (SV-ACS), and multi-vessel obstructive ACS (MV-ACS). MINOCA patients (5.2% of the total population) were more likely to be female (51.5% vs. 30.3% and 26.0% in SV-ACS and MV-ACS, respectively, p < 0.001 for both). The prevalence of risk factors in the MINOCA group was in between the SV-ACS and MV-ACS groups. Logistic regression revealed a lower odds of dying in SV-ACS (odds ratio (OR) = 0.70 (p = 0.04)) and a similar odds in MV-ACS (OR = 0.88, p = 0.45) compared to MINOCA.
Patients with MINOCA show an 'intermediate' risk profile with mortality rates in between those of both ACS groups. Hence, MINOCA should be recognised as a potential risk factor for mortality, requiring adequate treatment and follow-up.
患有心肌梗死但冠状动脉无阻塞（MINOCA）的患者是否比患有阻塞性冠状动脉疾病的患者有更好的预后仍存在争议。本研究聚焦于MINOCA患者的临床特征和预后。
我们对2006年至2014年期间入住荷兰兹沃勒市伊萨拉医院的急性冠状动脉综合征（ACS）患者进行了回顾性分析。总共7693名患者被分为三组：MINOCA、单支血管阻塞性ACS（SV-ACS）和多支血管阻塞性ACS（MV-ACS）。MINOCA患者（占总人口的5.2%）更可能为女性（分别为51.5%，而SV-ACS和MV-ACS中女性占比分别为30.3%和26.0%，两者p均<0.001）。MINOCA组的危险因素患病率介于SV-ACS组和MV-ACS组之间。逻辑回归显示，与MINOCA相比，SV-ACS患者死亡几率较低（比值比（OR）=0.70，p=0.04），MV-ACS患者死亡几率相似（OR=0.88，p=0.45）。
MINOCA患者呈现出“中等”风险特征，死亡率介于两组ACS患者之间。因此，MINOCA应被视为死亡的潜在危险因素，需要进行适当治疗和随访。
