心肌梗死伴非阻塞性冠状动脉病变（MINOCA）侵入性评估时的病理结果：一项系统评价和荟萃分析

Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.

作者信息

Fedele Damiano, Cavallo Daniele, Bodega Francesca, Suma Nicole, Canton Lisa, Ciarlantini Mariachiara, Ryabenko Khrystyna, Amicone Sara, Marinelli Virginia, Asta Claudio, Pastore Giuseppe, Casuso Alvarez Marcello, Belà Rebecca, Sansonetti Angelo, Angeli Francesco, Armillotta Matteo, Foà Alberto, Bergamaschi Luca, Paolisso Pasquale, Belmonte Marta, Rucci Paola, Barbato Emanuele, Pizzi Carmine

机构信息

Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico di Sant'Orsola, Bologna, Emilia-Romagna, Italy.

Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy.

出版信息

Heart. 2025 Mar 13;111(7):291-299. doi: 10.1136/heartjnl-2024-324565.

DOI:10.1136/heartjnl-2024-324565

PMID:39689931

Abstract

BACKGROUND

Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.

METHODS

Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year).

RESULTS

Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up.

CONCLUSIONS

Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm.

PROSPERO REGISTRATION NUMBER

CRD42023468183.

摘要

背景

非阻塞性冠状动脉心肌梗死（MINOCA）的病理机制具有异质性，对预后的影响尚不清楚，在临床实践中常未被识别。本研究旨在评估侵入性冠状动脉造影（ICA）、光学相干断层扫描（OCT）和冠状动脉功能测试在MINOCA中的病理发现患病率及其对预后的影响。

方法

在PubMed和SCOPUS上检索截至2023年8月发表的研究，纳入报告通过ICA评估非阻塞性冠状动脉（NObs-CA；冠状动脉狭窄1%-49%）与正常冠状动脉（NCA；冠状动脉狭窄0%）患者的患病率、MINOCA中OCT的病理发现和/或冠状动脉血管舒缩试验的研究。采用纽卡斯尔-渥太华量表进行质量评估。使用随机效应模型估计病理发现的合并患病率。计算短期（<1个月）、1年和长期随访（>1年）时NObs-CA患者与NCA患者全因死亡、心肌梗死以及两者复合事件的合并风险比（RR）及95%置信区间（CI）。

结果

分析了45项研究，共17539例患者。ICA显示NObs-CA的合并患病率为53%（95%CI 0.47至0.60）。OCT显示62%（95%CI 0.44至0.78）的患者有急性病理发现，冠状动脉血管舒缩试验49%呈阳性（95%CI 0.31至0.67）。与NCA相比，NObs-CA与全因死亡或心肌梗死的1年风险增加相关（RR=1.49（95%CI 1.17至1.90））以及单独心肌梗死的风险增加相关（RR=1.80（95%CI 1.26至2.59）），而全因死亡风险相当。长期随访时结果相似，但短期随访时未观察到。