Cardiology Department, Hospital de Braga, Braga, Portugal.
School of Medicine, University of Minho, Braga, Portugal.
Rev Port Cardiol. 2024 Jul;43(7):417-425. doi: 10.1016/j.repc.2023.12.010. Epub 2024 Mar 15.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is responsible for about 10% of all acute myocardial infarctions (AMI). Therapeutic strategies and prognosis depend on the underlying etiology, and a multimodal approach is essential. The objectives of this study were to characterize the group of patients diagnosed with MINOCA and to valuate the diagnostic yield of cardiovascular magnetic resonance (CMR).
This was a retrospective, observational, and analytical study, including 516 patients admitted for a non-ST-elevation MI and with no significant coronary disease on coronary angiography between January 2016 and September 2021.
After the inclusion criteria, 163 patients remained of the 516 admitted to the study. They were divided into four groups based on the CMR results: MINOCA (n=51), Takotsubo syndrome (n=37), myocarditis (n=33), and without diagnosis (n=42). Most patients diagnosed with MINOCA were female with a mean age of 61.06±13.83 years. CMR identified the diagnosis in 74.2% of patients admitted for suspected acute MI, in which coronary angiography showed the absence of significant obstructions. The median time between hospital admission and CMR was significantly shorter in the groups that had a diagnosis compared with the group with no diagnosis (p=0.038), with a significant increase in diagnostic profitability if CMR was performed up to 14 days after admission (p=0.022). There were no deaths of cardiovascular etiology during the follow-up period.
CMR was fundamental as it identified the diagnosis in three out of four patients; it should be performed in the first 14 days.
非阻塞性冠状动脉心肌梗死（MINOCA）占所有急性心肌梗死（AMI）的 10%左右。治疗策略和预后取决于潜在病因，因此需要采用多模式方法。本研究的目的是描述诊断为 MINOCA 的患者群体，并评估心血管磁共振（CMR）的诊断效果。
这是一项回顾性、观察性和分析性研究，纳入了 2016 年 1 月至 2021 年 9 月期间因非 ST 段抬高型心肌梗死且冠状动脉造影无明显冠状动脉疾病而住院的 516 例患者。
在纳入标准后，从 516 例入院患者中保留了 163 例。根据 CMR 结果将他们分为四组：MINOCA（n=51）、心尖球形综合征（Takotsubo syndrome，n=37）、心肌炎（n=33）和无诊断（n=42）。大多数诊断为 MINOCA 的患者为女性，平均年龄为 61.06±13.83 岁。CMR 对 74.2%的因疑似急性 MI 入院的患者进行了诊断，这些患者的冠状动脉造影显示无明显阻塞。与无诊断组相比，在诊断组中，从入院到 CMR 的中位时间显著缩短（p=0.038），如果在入院后 14 天内进行 CMR，诊断的收益显著增加（p=0.022）。在随访期间，没有因心血管病因导致的死亡。
CMR 至关重要，因为它确定了四分之三患者的诊断，应在入院后的 14 天内进行。
