Oh Seok, Cho Kyung Hoon, Kim Min Chul, Sim Doo Sun, Hong Young Joon, Kim Ju Han, Ahn Youngkeun, Jeong Myung Ho
Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Department of Cardiology, Chonnam National University Medical School, Gwangju, Korea.
Korean Circ J. 2024 Nov;54(11):693-706. doi: 10.4070/kcj.2024.0085. Epub 2024 Jun 17.
Real-world evidence on the relationship between delayed hospitalization and outcomes in myocardial infarction with nonobstructive coronary arteries (MINOCA) is lacking. Hence, we aimed to evaluate the clinical characteristics of patients with MINOCA and the 2-year mortality outcomes in this patient population according to the symptom-to-door time (SDT).
Overall, 861 patients with MINOCA from 2 Korean nationwide observational registries (2011-2020) were included and categorized as early or late presenters. Late presentation was defined as SDT ≥12 hours in patients with ST-segment elevation myocardial infarction (STEMI) and SDT ≥24 hours in patients with non-STEMI. The primary outcome was 2-year all-cause mortality. Propensity score matching (PSM) and age-sex adjusted analysis were used to determine whether late presentation independently affected mortality. Multivariate logistic regression analysis was used to examine the independent factors correlated with late presentation.
In unadjusted data, late presenters had a notably higher risk of 2-year all-cause mortality than early presenters (hazard ratio [HR], 2.44; 95% confidence interval [CI], 1.47-4.08). This trend persisted in age-sex adjusted analysis (adjusted HR, 2.29; 95% CI, 1.36-3.84) and PSM-adjusted analysis (adjusted HR, 2.18; 95% CI, 1.05-4.53). The positive independent factors for late presentation included female sex, no emergency medical service use and high creatinine level, whereas the negative independent factor was a dyslipidemia.
Late presentation is associated with higher mortality in patients with MINOCA. Multidisciplinary efforts are needed to reduce pre-hospital delay, thereby improving the clinical outcomes in these patients.
缺乏关于延迟住院与非阻塞性冠状动脉心肌梗死（MINOCA）患者预后之间关系的真实世界证据。因此，我们旨在根据症状到入院时间（SDT）评估MINOCA患者的临床特征以及该患者群体的2年死亡率结局。
总共纳入了来自韩国两个全国性观察登记处（2011 - 2020年）的861例MINOCA患者，并将其分为早期就诊者或晚期就诊者。晚期就诊定义为ST段抬高型心肌梗死（STEMI）患者的SDT≥12小时，非STEMI患者的SDT≥24小时。主要结局是2年全因死亡率。倾向评分匹配（PSM）和年龄 - 性别调整分析用于确定晚期就诊是否独立影响死亡率。多变量逻辑回归分析用于检查与晚期就诊相关的独立因素。
在未调整的数据中，晚期就诊者2年全因死亡率的风险显著高于早期就诊者（风险比[HR]，2.44；95%置信区间[CI]，1.47 - 4.08）。这一趋势在年龄 - 性别调整分析（调整后HR，2.29；95% CI，1.36 - 3.84）和PSM调整分析（调整后HR，2.18；95% CI，1.05 - 4.53）中持续存在。晚期就诊的正向独立因素包括女性、未使用紧急医疗服务和高肌酐水平，而负向独立因素是血脂异常。
晚期就诊与MINOCA患者较高的死亡率相关。需要多学科努力来减少院前延误，从而改善这些患者的临床结局。
