Bahar Abdul Rasheed, Bahar Yasemin, Kaur Paawanjot, Kidess George, Jawadi Mohamad Hasan, Alrayyashi Mohamed S, Bolaji Olayiwola, Paul Timir K, Alraies M Chadi
Detroit Medical Center/ Wayne State University, Detroit, MI, USA (
Wayne State University, Detroit, MI, USA (
Crit Pathw Cardiol. 2025 Apr 30. doi: 10.1097/HPC.0000000000000391.
Myocardial Infarction with non-obstructive coronary arteries (MINOCA) is defined as myocardial infarction with <50% stenosis of coronary arteries. Atrial fibrillation (AF) is a common arrhythmia that may influence MINOCA outcomes.
We performed a retrospective analysis of the National Inpatient Sample (2016-2021), identifying MINOCA patients with and without AF using ICD-10-CM codes. Multivariable mixed-effects logistic regression and propensity score matching were applied to control for confounders and assess outcomes.
Of 94,840 MINOCA patients, 28,270 (30%) had AF. AF was associated with higher in-hospital mortality (3.74% vs. 2.75%, p=0.004), acute heart failure (38.33% vs. 34.97%, p<0.001), sudden cardiac arrest (2.54% vs. 1.73%, p<0.050), and cardiogenic shock (3.11% vs. 1.56%, p<0.001). AF independently predicted in-hospital mortality (adjusted odds ratio; aOR 1.3, 95% CI: 1.07-1.58, p<0.001), heart failure (aOR: 1.48, 95% CI: 1.38-1.59, p<0.001), cardiogenic shock (aOR: 1.85, 95% CI: 1.48-2.30, p<0.001), and acute kidney injury (aOR: 1.15, 95% CI: 1.07-1.24, p<0.001). There were no significant differences in percutaneous coronary intervention, mechanical circulatory support, or defibrillator use (p>0.050).
AF in MINOCA is associated with worse in-hospital outcomes, including mortality, heart failure, acute kidney injury, and cardiogenic shock. AF may be a key prognostic marker in this population, warranting further research.
非阻塞性冠状动脉心肌梗死（MINOCA）定义为冠状动脉狭窄<50%的心肌梗死。心房颤动（AF）是一种常见的心律失常，可能影响MINOCA的预后。
我们对国家住院患者样本（2016 - 2021年）进行了回顾性分析，使用ICD - 10 - CM编码识别有和没有AF的MINOCA患者。应用多变量混合效应逻辑回归和倾向评分匹配来控制混杂因素并评估预后。
在94,840例MINOCA患者中，28,270例（30%）有AF。AF与更高的住院死亡率（3.74%对2.75%，p = 0.004）、急性心力衰竭（38.33%对34.97%，p < 0.001）、心搏骤停（2.54%对1.73%，p < 0.050）和心源性休克（3.11%对1.56%，p < 0.001）相关。AF独立预测住院死亡率（调整后的优势比；aOR 1.3，95%置信区间：1.07 - 1.58，p < 0.001）、心力衰竭（aOR：1.48，95%置信区间：1.38 - 1.59，p < 0.001）、心源性休克（aOR：1.85，95%置信区间：1.48 - 2.30，p < 0.001）和急性肾损伤（aOR：1.15，95%置信区间：1.07 - 1.24，p < 0.001）。在经皮冠状动脉介入治疗、机械循环支持或除颤器使用方面没有显著差异（p > 0.050）。
MINOCA中的AF与更差的住院结局相关，包括死亡率、心力衰竭、急性肾损伤和心源性休克。AF可能是该人群的一个关键预后标志物，值得进一步研究。
