Kacmaz Mustafa, Schlettert Clara, Kreimer Fabienne, Abumayyaleh Mohammad, Akin Ibrahim, Mügge Andreas, Aweimer Assem, Hamdani Nazha, El-Battrawy Ibrahim
Institute of Physiology, Department of Cellular and Translational Physiology and Institute für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr-University Bochum, 44791 Bochum, Germany.
HCEMM-SU Cardiovascular Comorbidities Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary.
J Clin Med. 2024 May 11;13(10):2826. doi: 10.3390/jcm13102826.
The development and course of myocardial infarction with non-obstructive coronary artery (MINOCA) disease is still not fully understood. In this study, we aimed to examine the baseline characteristics of in-hospital outcomes and long-term outcomes of a cohort of troponin-positive patients without obstructive coronary artery disease based on different left ventricular ejection fractions (LVEFs). We included a cohort of 254 patients (mean age: 64 (50.8-75.3) years, 120 females) with suspected myocardial infarction and no obstructive coronary artery disease (MINOCA) in our institutional database between 2010 and 2021. Among these patients, 170 had LVEF ≥ 50% (84 females, 49.4%), 31 patients had LVEF 40-49% (15 females, 48.4%), and 53 patients had LVEF < 40% (20 females, 37.7%). The mean age in the LVEF ≥ 50% group was 61.5 (48-73) years, in the LVEF 40-49% group was 67 (57-78) years, and in the LVEF < 40% group was 68 (56-75.5) years ( = 0.05). The mean troponin value was highest in the LVEF < 40% group, at 3.8 (1.7-4.6) µg/L, and lowest in the LVEF ≥ 50% group, at 1.1 (0.5-2.1) µg/L ( = 0.05). Creatine Phosphokinase (CK) levels were highest in the LVEF ≥ 50% group (156 (89.5-256)) and lowest in the LVEF 40-49% group (127 (73-256)) ( < 0.05), while the mean BNP value was lowest in the LVEF ≥ 50% group (98 (48-278) pg/mL) and highest in the <40% group (793 (238.3-2247.5) pg/mL) ( = 0.001). Adverse in-hospital cardiovascular events were highest in the LVEF < 40% group compared to the LVEF 40-49% group and the LVEF ≥ 50% group (56% vs. 55% vs. 27%; < 0.001). Over a follow-up period of 6.2 ± 3.1 years, the all-cause mortality was higher in the LVEF < 40% group compared to the LVEF 40-49% group and the LVEF ≥ 50% group. Among the different factors, LVEF < 40% and LVEF 40-49% were associated with an increased risk of in-hospital cardiovascular events in the multivariable Cox regression analysis. : LVEF has different impacts on in-hospital cardiovascular events in this cohort. Furthermore, LVEF influences long-term all-cause mortality.
非阻塞性冠状动脉（MINOCA）疾病所致心肌梗死的发展过程仍未完全明确。在本研究中，我们旨在基于不同的左心室射血分数（LVEF），研究一组肌钙蛋白阳性且无阻塞性冠状动脉疾病患者的院内结局和长期结局的基线特征。我们纳入了2010年至2021年期间机构数据库中254例疑似心肌梗死且无阻塞性冠状动脉疾病（MINOCA）的患者（平均年龄：64（50.8 - 75.3）岁，女性120例）。在这些患者中，170例LVEF≥50%（女性84例，49.4%），31例LVEF为40 - 49%（女性15例，48.4%），53例LVEF<40%（女性20例，37.7%）。LVEF≥50%组的平均年龄为61.5（48 - 73）岁，LVEF为40 - 49%组为67（57 - 78）岁，LVEF<40%组为68（56 - 75.5）岁（P = 0.05）。LVEF<40%组的肌钙蛋白平均水平最高，为3.8（1.7 - 4.6）μg/L，LVEF≥50%组最低，为1.1（0.5 - 2.1）μg/L（P = 0.05）。肌酸磷酸激酶（CK）水平在LVEF≥50%组最高（156（89.5 - 256）），在LVEF为40 - 49%组最低（127（73 - 256））（P<0.05），而脑钠肽（BNP）平均水平在LVEF≥50%组最低（98（48 - 278）pg/mL），在<40%组最高（793（238.3 - 2247.5）pg/mL）（P = 0.001）。与LVEF为40 - 49%组和LVEF≥50%组相比，LVEF<40%组的院内不良心血管事件发生率最高（56%对55%对27%；P<0.001）。在6.2±3.1年的随访期内，LVEF<40%组的全因死亡率高于LVEF为40 - 49%组和LVEF≥50%组。在多变量Cox回归分析中，不同因素中，LVEF<40%和LVEF为40 - 49%与院内心血管事件风险增加相关。结论：LVEF对该队列中的院内心血管事件有不同影响。此外，LVEF影响长期全因死亡率。
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