Pasupathy Sivabaskari, La Sarena, Tavella Rosanna, Zeitz Christopher, Worthley Matthew, Sinhal Ajay, Arstall Margaret, Beltrame John F
School of Medicine, Faculty of Health Sciences, The University of Adelaide, Adelaide, SA 5000, Australia.
Central Adelaide Local Health Network, Adelaide, SA 5000, Australia.
J Clin Med. 2023 Jul 10;12(14):4595. doi: 10.3390/jcm12144595.
The universal definition of acute myocardial infarction (MI) requires both evidence of myocardial injury and myocardial ischaemia. In MINOCA (MI with non-obstructive coronary arteries), patients must fulfil this MI criteria, but is their chest pain similar to those who have MI with obstructive CAD (MICAD)? This study compares prospectively collected chest pain features between patients with MINOCA and MICAD. Utilising the Coronary Angiogram Database of South Australia (CADOSA), consecutive MI patients were categorized as MINOCA or MICAD based on angiographic findings. Chest pain data were collected via direct patient interviews by trained staff members. Of 6811 consecutive patients fulfilling a clinical MI diagnosis, 411 (6.0%) were MINOCA, and 5948 MICAD. The MINOCA patients were younger, more often female and had less cardiovascular risk factors than those with MICAD. There were no significant differences in chest pain characteristics between the MINOCA and MICAD cohorts in relation to pain location, quality, associated symptoms, or duration. In conclusion, MINOCA patients have chest pain characteristics that are indistinguishable from MICAD patients, suggesting that their pain is ischaemic in nature. Thus, in the presence of positive myocardial injury markers, ischaemic chest pain fulfils the universal criteria for MI, despite the absence of obstructive coronary artery disease.
急性心肌梗死（MI）的通用定义要求同时具备心肌损伤和心肌缺血的证据。在心肌梗死伴非阻塞性冠状动脉病变（MINOCA）患者中，必须满足这一心肌梗死标准，但他们的胸痛与心肌梗死伴阻塞性冠状动脉疾病（MICAD）患者的胸痛相似吗？本研究前瞻性地比较了MINOCA和MICAD患者的胸痛特征。利用南澳大利亚冠状动脉造影数据库（CADOSA），根据血管造影结果将连续的心肌梗死患者分为MINOCA或MICAD。胸痛数据通过训练有素的工作人员直接对患者进行访谈收集。在连续6811例符合临床心肌梗死诊断的患者中，411例（6.0%）为MINOCA，5948例为MICAD。MINOCA患者比MICAD患者更年轻，女性更多，心血管危险因素更少。MINOCA和MICAD队列在胸痛特征方面，在疼痛部位、性质、相关症状或持续时间上没有显著差异。总之，MINOCA患者的胸痛特征与MICAD患者难以区分，表明他们的疼痛本质上是缺血性的。因此，在存在阳性心肌损伤标志物的情况下，尽管没有阻塞性冠状动脉疾病，缺血性胸痛也符合心肌梗死的通用标准。
