Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands (R.E.K., S.E.E.-S., R.N.).
Duke Cardiovascular Magnetic Resonance Center (R.E.K., M.P., L.B., Y.K., F.A., R.J.K.), Duke University Medical Center, Durham, NC.
Circ Cardiovasc Imaging. 2023 Aug;16(8):e014454. doi: 10.1161/CIRCIMAGING.122.014454. Epub 2023 Aug 15.
Patients with a working diagnosis of myocardial infarction with unobstructed coronary arteries (MINOCA) represent a heterogeneous cohort. The prognosis could vary substantially depending on the underlying cause. Although cardiac magnetic resonance (CMR) is considered a key diagnostic tool in these patients, there are limited data linking the CMR diagnosis with the outcome.
This study is a prospective outcomes registry of consecutive patients presenting with a working diagnosis of MINOCA who were clinically referred for CMR at an academic hospital from October 2003 to February 2020. We assessed the relationships between the prespecified CMR diagnoses of acute myocardial infarction (AMI), myocarditis, nonischemic cardiomyopathy (NICM), normal CMR study, and major adverse cardiac events (MACEs).
Of 252 patients, the CMR diagnosis was AMI in 63 (25%), myocarditis in 33 (13%), NICM in 111 (44%), normal CMR in 37 (15%), and other diagnoses in 8 (3%). A specific nonischemic cause was diagnosed allowing true MINOCA to be ruled-out in 57% of the cohort. During up to 10 years of follow-up (1595 patient-years), MACE occurred in 84 patients (33%), which included 64 deaths (25%). The unadjusted cumulative 10-year rate of MACE was 47% in AMI, 24% in myocarditis, 50% in NICM, and 3.5% in patients with a normal CMR (Log-rank <0.001). The CMR diagnosis provided incremental prognostic value over clinical factors including age, gender, coronary artery disease risk factors, presentation with ST-elevation, and peak troponin (incremental χ² 17.9, <0.001); and patients with diagnoses of AMI, myocarditis, and NICM had worse MACE-free survival than patients with a normal CMR.
In patients with a working diagnosis of MINOCA, CMR allows ruling-out true MINOCA in over half of the patients. CMR diagnoses of AMI, myocarditis, and NICM are associated with worse MACE-free survival, whereas a normal CMR study portends a benign prognosis.
经冠状动脉造影未阻塞诊断为心肌梗死的患者（MINOCA）代表了一组异质性队列。预后可能因潜在病因而有很大差异。虽然心脏磁共振（CMR）被认为是这些患者的关键诊断工具，但将 CMR 诊断与结果联系起来的数据有限。
本研究是对 2003 年 10 月至 2020 年 2 月在一家学术医院因临床指征接受 CMR 检查的连续确诊为 MINOCA 的患者进行的前瞻性结局登记研究。我们评估了 CMR 诊断为急性心肌梗死（AMI）、心肌炎、非缺血性心肌病（NICM）、正常 CMR 研究和主要不良心脏事件（MACE）之间的关系。
在 252 名患者中，CMR 诊断为 AMI 的患者有 63 例（25%），心肌炎的患者有 33 例（13%），NICM 的患者有 111 例（44%），正常 CMR 的患者有 37 例（15%），其他诊断的患者有 8 例（3%）。有明确的非缺血性病因，排除了真正的 MINOCA 57%的患者。在长达 10 年的随访（1595 患者-年）中，84 名患者（33%）发生了 MACE，其中 64 人死亡（25%）。未调整的 10 年累积 MACE 发生率在 AMI 患者中为 47%，心肌炎患者中为 24%，NICM 患者中为 50%，正常 CMR 患者中为 3.5%（对数秩检验<0.001）。CMR 诊断较临床因素（包括年龄、性别、冠心病危险因素、ST 段抬高表现和肌钙蛋白峰值）提供了额外的预后价值（增量χ²17.9，<0.001）；而 AMI、心肌炎和 NICM 诊断的患者无 MACE 生存率较差。
在确诊为 MINOCA 的患者中，CMR 可排除超过一半的患者存在真正的 MINOCA。CMR 诊断为 AMI、心肌炎和 NICM 与无 MACE 生存率较差相关，而正常 CMR 研究预示着良性预后。
