Aleksova Aneta, Fluca Alessandra Lucia, Janjusevic Milijana, Padoan Laura, Pierri Alessandro, Chiaradia Vincenzo, Munaretto Laura, Merro Enzo, Barbati Giulia, Hiche Cristina, Gabrielli Marco, Lovadina Stefano, Beltrame Daria, D'Errico Stefano, Saw Jacqueline, Fabris Enrico, Di Lenarda Andrea, Sinagra Gianfranco
Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Laboratory of Molecular Cardiology, Department of Medical Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.
Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Laboratory of Molecular Cardiology, Department of Medical Surgical and Health Sciences, Cattinara Hospital, University of Trieste, Trieste, Italy.
Int J Cardiol. 2025 Feb 1;420:132745. doi: 10.1016/j.ijcard.2024.132745. Epub 2024 Nov 26.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) and type 2 myocardial infarction (MI), both presenting as non-ST-elevation MI (NSTEMI), are often grouped together due to overlapping symptoms. The aim of our study is to compare their characteristics and prognosis to distinguish between them.
Among 7815 patients with NSTEMI who underwent coronary angiography between 2005 and 2022 we identified 538 patients with diagnosis of MINOCA (n = 301; 3,9 %) and type 2 MI (n = 237; 3 %). The outcome was a composite of all-cause mortality, non-fatal MI, hospitalisation for heart failure (HF) and transitory ischemic attack or non-fatal stroke.
The mean age of the entire cohort was 68 (11.5) years, with women being the most frequently represented group (65 %). Comparing the sub-cohorts, MINOCA patients were younger (66.3 (11.7) Vs. 70.6 (11) years, p < 0.01), and less likely to have typical cardiovascular risk than type 2 MI patients. At multivariable analysis different clinical (age, heart rate, typical chest pain, palpitations, postmenopausal status), and instrumental (cardiac rhythm, ST-segment changes, diastolic dysfunction, hypo/akinesia with non-coronary distribution) variables were independent predictors of MINOCA with AUC of 0.83 [95 % CI, 0.78-0.88], p < 0.01 at ROC analysis. At a median follow-up of 61 (IQR 34-100) months, MINOCA patients had significantly lower rate of the composite endpoint compared to type 2 MI (20 % Vs. 32 %, p < 0.01).
MINOCA cohort was associated with different characteristics compared to type 2 MI and had a better prognosis despite the number of events was not negligible.
非阻塞性冠状动脉心肌梗死（MINOCA）和2型心肌梗死（MI）均表现为非ST段抬高型心肌梗死（NSTEMI），由于症状重叠，常被归为一类。我们研究的目的是比较它们的特征和预后，以进行区分。
在2005年至2022年间接受冠状动脉造影的7815例NSTEMI患者中，我们确定了538例诊断为MINOCA的患者（n = 301；3.9%）和2型MI患者（n = 237；3%）。结局为全因死亡率、非致命性MI、因心力衰竭（HF）住院以及短暂性脑缺血发作或非致命性卒中的综合情况。
整个队列的平均年龄为68（11.5）岁，女性是最常见的群体（65%）。比较亚队列，MINOCA患者更年轻（66.3（11.7）岁对70.6（11）岁，p < 0.01），且与2型MI患者相比，具有典型心血管危险因素的可能性更小。在多变量分析中，不同的临床（年龄、心率、典型胸痛、心悸、绝经后状态）和仪器检查（心律、ST段改变、舒张功能障碍、非冠状动脉分布区域的运动减弱/运动消失）变量是MINOCA的独立预测因素，ROC分析时AUC为0.83 [95% CI，0.78 - 0.88]，p < 0.01。在中位随访61（IQR 34 - 100）个月时，MINOCA患者的复合终点发生率显著低于2型MI患者（20%对32%，p < 0.01）。
与2型MI相比，MINOCA队列具有不同的特征，尽管事件数量不可忽视，但其预后更好。
