Department of Cardiology.
Department of Anatomy, Gaziosmanpasa University School of Medicine, Tokat, Turkey.
Am J Cardiol. 2022 May 15;171:28-31. doi: 10.1016/j.amjcard.2022.01.043. Epub 2022 Mar 11.
Coronary artery ectasia (CAE) is associated with an increased risk for acute myocardial infarction (AMI). A significant proportion of patients with AMI have no obstructive coronary artery disease (CAD), however, the underlying mechanism of myocardial infarction with nonobstructive coronary arteries (MINOCA) is poorly understood. Therefore, the present study aimed to investigate whether CAE has a role in the pathogenesis of MINOCA. A total of 1,284 patients who were admitted with a diagnosis of non-ST-segment elevation myocardial infarction were included in the study. Patients were divided into 2 groups according to the presence or absence of obstructive CAD (≥50% stenosis). Patients without obstructive CAD (MINOCA group) and patients with obstructive CAD (no-MINOCA group) were compared regarding the frequency of CAE. Additionally, the association between CAE and MINOCA was investigated. In the study participants, 101 patients (7.9%) were diagnosed with MINOCA, whereas 1,183 (92.1%) had AMI with obstructive CAD. Importantly, the frequency of patients with CAE was significantly higher in patients with MINOCA compared with those with obstructive CAD (22.8% vs 3.5%, p <0.001). Moreover, CAE was observed in 64 patients (4.9%). The frequency of MINOCA was found to be significantly higher in patients with CAE compared with patients without CAE (35.9% vs 6.4%, p <0.001). Furthermore, multivariate analysis demonstrated that the presence of CAE was an independent predictor of MINOCA in patients presented with a diagnosis of non-ST-segment elevation myocardial infarction (odds ratio 1.812, 95% confidence interval 1.376 to 2.581, p <0.001). In conclusion, CAE may be considered as a risk factor for MINOCA and may have a role in the pathophysiology of MINOCA.
冠状动脉扩张（CAE）与急性心肌梗死（AMI）的风险增加相关。然而，很大一部分 AMI 患者没有阻塞性冠状动脉疾病（CAD），但非阻塞性冠状动脉心肌梗死（MINOCA）的潜在机制尚未完全了解。因此，本研究旨在探讨 CAE 是否在 MINOCA 的发病机制中起作用。共纳入 1284 例诊断为非 ST 段抬高型心肌梗死的患者。根据是否存在阻塞性 CAD（≥50%狭窄）将患者分为 2 组。比较无阻塞性 CAD（MINOCA 组）和有阻塞性 CAD（无 MINOCA 组）患者 CAE 的发生率。此外，还研究了 CAE 与 MINOCA 的关系。在研究参与者中，101 例（7.9%）被诊断为 MINOCA，而 1183 例（92.1%）患有 AMI 伴阻塞性 CAD。重要的是，MINOCA 患者中 CAE 的发生率明显高于阻塞性 CAD 患者（22.8% vs. 3.5%，p <0.001）。此外，在 64 例患者（4.9%）中观察到 CAE。与无 CAE 患者相比，CAE 患者 MINOCA 的发生率明显更高（35.9% vs. 6.4%，p <0.001）。此外，多变量分析表明，在诊断为非 ST 段抬高型心肌梗死的患者中，存在 CAE 是 MINOCA 的独立预测因素（比值比 1.812，95%置信区间 1.376 至 2.581，p <0.001）。总之，CAE 可被视为 MINOCA 的危险因素，并可能在 MINOCA 的病理生理学中起作用。
