Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Cardiol J. 2022;29(5):798-806. doi: 10.5603/CJ.a2020.0146. Epub 2020 Nov 3.
A definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) was published by European Society of Cardiology in 2016. The aim of this study is to analyze the clinical profile and prognosis of these patients in a prospective single-center study and compare it with the literature data.
During a 3-year period, information from every consecutive MINOCA patient was gathered (n = 109). It was then compared with 412 contemporaneous patients with myocardial infarction and obstructive coronary arteries (MIOCA). Univariate and multivariate analyses were performed. Prognosis analysis was adjusted by age and cardiovascular risk factors (CVRF).
MINOCA represented 16.9% of the total of patients admitted for myocardial infarction (MI). Compared with MIOCA, they had more psychosocial disorders (22.9% vs. 10.7%; p < 0.01) and more pro-inflammatory conditions (34.9% vs. 14.0%; p < 0.01). Atrial fibrillation was twice as frequent in MINOCA (14.7% vs. 7.3%; p = 0.016). Predictors of MINOCA were as follows: female gender, absence of diabetes, absence of tobacco use, tachycardia, troponin above 10 times the 99th percentile, and proinflammatory conditions. Median follow-up was 17.3 ± 9.3 months. Major adverse cardiovascular events (MACE; a composite of a recurrence of acute MI, transient ischemic attack/stroke, or death from cardiovascular cause and death from any cause) occurred in 10.8% of the MINOCA group as compared with 10.7% in the MIOCA group (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.58-2.45; p = 0.645). Cardiovascular re-admission rates were higher in the MINOCA group: 19.8% vs. 13.9% (HR 1.85; CI 1.06-3.21; p = 0.030).
The frequency of MINOCA is high, with fewer CVRF, and it is linked to atrial fibrillation, psychosocial disorders, and pro-inflammatory conditions. Mid-term prognosis is worse than previously thought, with a similar proportion of MACE as compared to MIOCA, and even a higher rate of cardiovascular re-admissions.
欧洲心脏病学会于 2016 年发布了非阻塞性冠状动脉心肌梗死（MINOCA）的定义。本研究旨在通过前瞻性单中心研究分析这些患者的临床特征和预后，并与文献数据进行比较。
在 3 年期间，收集了每例连续的 MINOCA 患者的信息（n=109）。然后将其与同时期 412 例心肌梗死和阻塞性冠状动脉疾病（MIOCA）患者进行比较。进行了单变量和多变量分析。预后分析根据年龄和心血管危险因素（CVRF）进行了调整。
MINOCA 占因心肌梗死（MI）住院患者总数的 16.9%。与 MIOCA 相比，MINOCA 患者的心理社会障碍更多（22.9% vs. 10.7%；p<0.01），促炎状态更多（34.9% vs. 14.0%；p<0.01）。MINOCA 中房颤的发生率是 MIOCA 的两倍（14.7% vs. 7.3%；p=0.016）。MINOCA 的预测因素如下：女性、无糖尿病、无吸烟史、心动过速、肌钙蛋白高于第 99 百分位的 10 倍、促炎状态。中位随访时间为 17.3±9.3 个月。MINOCA 组主要不良心血管事件（MACE；急性 MI 复发、短暂性脑缺血发作/中风、心血管原因导致的死亡和任何原因导致的死亡的复合事件）发生率为 10.8%，MIOCA 组为 10.7%（风险比[HR]1.19，95%置信区间[CI]0.58-2.45；p=0.645）。MINOCA 组心血管再入院率更高：19.8% vs. 13.9%（HR 1.85；CI 1.06-3.21；p=0.030）。
MINOCA 的频率较高，CVRF 较少，与房颤、心理社会障碍和促炎状态有关。中期预后比以前认为的更差，与 MIOCA 相比，MACE 的比例相似，甚至心血管再入院率更高。
