Discipline of Medicine, The University of Adelaide, Australia (S.P., P.L., R.T., T.A., C.Z., J.F.B.).
Department of Cardiology, Central Adelaide Local Health Network, Australia (S.P., R.T., C.Z., J.F.B.).
Circ Cardiovasc Qual Outcomes. 2021 Nov;14(11):e007880. doi: 10.1161/CIRCOUTCOMES.121.007880. Epub 2021 Nov 16.
Suspected myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) occurs in ≈5% to 10% of patients with MI referred for coronary angiography. The prognosis of these patients may differ to those with MI and obstructive coronary artery disease (MI-CAD) and those without a MI (patients without known history of MI [No-MI]). The primary objective of this study is to evaluate the 12-month all-cause mortality of patients with MINOCA.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the terms "MI," "nonobstructive," "angiography," and "prognosis" were searched in PubMed and Embase databases from inception to December 2018, including original, English language MINOCA studies with >100 consecutive patients. Publications with a heterogeneous cohort, unreported coronary stenosis, or exclusively focusing on MINOCA-mimicking conditions, were excluded. Unpublished data were obtained from the MINOCA Global Collaboration. Data were pooled and analyzed using Paule-Mandel, Hartung, Knapp, Sidik & Jonkman, or restricted maximum-likelihood random-effects meta-analysis methodology. Heterogeneity was assessed using Cochran's Q and I statistics. The primary outcome was 12-month all-cause mortality in patients with MINOCA, with secondary comparisons to MI-CAD and No-MI.
The 23 eligible studies yielded 55 369 suspected MINOCA, 485 382 MI-CAD, and 33 074 No-MI. Pooled meta-analysis of 14 MINOCA studies accounting for 30 733 patients revealed an unadjusted 12-month all-cause mortality rate of 3.4% (95% CI, 2.6%-4.2%) and reinfarction (n=27 605; 10 studies) in 2.6% (95% CI, 1.7%-3.5%). MINOCA had a lower 12-month all-cause mortality than those with MI-CAD (3.3% [95% CI, 2.5%-4.1%] versus 5.6% [95% CI, 4.1%-7.0%]; odds ratio, 0.60 [95% CI, 0.52-0.70], <0.001). In contrast, there was a statistically nonsignificant trend towards increased 12-month all-cause mortality in patients with MINOCA (2.6% [95% CI, 0%-5.9%]) compared with No-MI (0.7% [95% CI, 0.1%-1.3%]; odds ratio, 3.71 [95% CI, 0.58-23.61], =0.09).
In the largest contemporary MINOCA meta-analysis to date, patients with suspected MINOCA had a favorable prognosis compared with MI-CAD, but statistically nonsignificant trend toward worse outcomes compared to those with No-MI. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020145356.
在因疑似心肌梗死（MI）而行冠状动脉造影的患者中，约有 5%至 10%存在非阻塞性冠状动脉（MINOCA）。这些患者的预后可能与 MI 合并阻塞性冠状动脉疾病（MI-CAD）患者和无 MI 患者（无已知 MI 病史的患者[No-MI]）不同。本研究的主要目的是评估 MINOCA 患者的 12 个月全因死亡率。
使用系统评价和荟萃分析的 Preferred Reporting Items 指南，在 PubMed 和 Embase 数据库中从成立到 2018 年 12 月，使用“MI”、“非阻塞性”、“血管造影”和“预后”等术语进行搜索，包括>100 例连续患者的原创性、英文 MINOCA 研究。排除了异质队列、未报告的冠状动脉狭窄或专门针对 MINOCA 模拟情况的出版物。未发表的数据来自 MINOCA 全球协作。使用 Paule-Mandel、Hartung、Knapp、Sidik 和 Jonkman 或受限最大似然随机效应荟萃分析方法对数据进行汇总和分析。使用 Cochran's Q 和 I 统计评估异质性。主要结局是 MINOCA 患者的 12 个月全因死亡率，次要比较是与 MI-CAD 和 No-MI 的比较。
23 项符合条件的研究共纳入了 55369 例疑似 MINOCA、485382 例 MI-CAD 和 33074 例 No-MI。对纳入的 14 项 MINOCA 研究进行汇总分析，共纳入 30733 例患者，结果显示未经调整的 12 个月全因死亡率为 3.4%（95%CI，2.6%-4.2%），再梗死率（n=27605；10 项研究）为 2.6%（95%CI，1.7%-3.5%）。MINOCA 的 12 个月全因死亡率低于 MI-CAD（3.3%[95%CI，2.5%-4.1%]与 5.6%[95%CI，4.1%-7.0%]；比值比，0.60[95%CI，0.52-0.70]，<0.001）。相比之下，MINOCA 患者的 12 个月全因死亡率与 No-MI（2.6%[95%CI，0%-5.9%]）相比呈统计学上无显著升高趋势（0.7%[95%CI，0.1%-1.3%]；比值比，3.71[95%CI，0.58-23.61]，=0.09）。
在迄今为止最大的当代 MINOCA 荟萃分析中，疑似 MINOCA 患者的预后与 MI-CAD 相比较好，但与 No-MI 相比，统计学上无显著升高的趋势。注册：网址：https://www.crd.york.ac.uk/PROSPERO/；独特标识符：CRD42020145356。
