Pham Ngoc Thach University of Medicine; Tam Duc Cardiology Hospital.
Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital.
Kardiologiia. 2024 Jul 31;64(7):56-63. doi: 10.18087/cardio.2024.7.n2526.
To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA).
This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years.
MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042).
The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.
研究与阻塞性冠状动脉心肌梗死（MIOCA）患者相比，非阻塞性冠状动脉心肌梗死（MINOCA）患者的临床和人口统计学特征、治疗选择和临床结局。
这是一项单中心前瞻性观察研究，纳入了 712 例急性心肌梗死（MI）患者，这些患者均常规接受直接冠状动脉造影检查。根据狭窄性冠状动脉粥样硬化的存在，患者被分为两组：MIOCA（冠状动脉狭窄≥50%）和 MINOCA（冠状动脉狭窄＜50%且无其他替代原因）。临床结局包括院内和长期总体死亡率以及心血管再住院率。中位随访时间为 1.5 年。
MINOCA 诊断为 73 例（10.3%）患者，其中 37 例（50%）为女性。MINOCA 患者的中位年龄为 61 岁，MIOCA 患者的中位年龄为 65 岁。MINOCA 患者与 MIOCA 患者的心血管危险因素无显著差异。MINOCA 病因中，53.4%为心肌耗氧量与供应量之间的差异，35.6%为高血压危象和肺水肿。MINOCA 的相关因素包括年龄≤58 岁、女性、无 ST 段抬高、无局部收缩功能障碍区、主动脉瓣狭窄和支气管-肺感染。MINOCA 患者不太可能接受乙酰水杨酸、P2Y12 抑制剂、双联抗血小板治疗、β受体阻滞剂和他汀类药物治疗（p＜0.05）。87.5%（n=623）的患者有长期结局数据。MIOCA 患者的院内死亡率（1.5% vs. 6.2%；p=0.161）和长期总体死亡率（6.1% vs. 14.7%；p=0.059）相当。MINOCA 组心血管再住院率较高（33.3% vs. 21.5%；p=0.042）。
在我们的研究中，所有急性 MI 患者中 MINOCA 的患病率为 10.3%。MINOCA 患者与 MIOCA 患者的一般公认心血管危险因素相当。MINOCA 患者的院内和长期死亡率预后相当，但更常需要心血管再住院治疗。
