Samaras Athanasios, Moysidis Dimitrios V, Papazoglou Andreas S, Rampidis Georgios P, Barmpagiannos Konstantinos, Barmpagiannos Antonios, Kalimanis Christos, Karagiannidis Efstratios, Fyntanidou Barbara, Kassimis George, Tzikas Apostolos, Ziakas Antonios, Fragakis Nikolaos, Kouskouras Konstantinos, Vassilikos Vassilios, Giannakoulas George
Second Cardiology Department, Hippokrateion University Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
J Clin Med. 2025 Apr 26;14(9):3006. doi: 10.3390/jcm14093006.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogenous clinical entity that differs in pathophysiology, treatment, and prognosis from myocardial infarction with obstructive coronary artery disease (MI-CAD) and MINOCA mimickers, such as myocarditis or Takotsubo syndrome. This study aimed to compare the clinical characteristics, imaging findings, management strategies, and long-term outcomes of patients with true MINOCA, MI-CAD, and MINOCA mimickers. This retrospective cohort study included 1596 patients hospitalized with acute myocardial infarction (AMI) between 2012 and 2024 at a tertiary university hospital. Patients were classified as having true MINOCA, MI-CAD, or MINOCA mimickers based on coronary angiography and advanced cardiac imaging. Data included clinical and laboratory variables, echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA). All-cause mortality was analyzed using Cox regression. Of 1596 AMI patients, 111 (7.0%) had true MINOCA, 1359 (85.1%) had MI-CAD, and 127 (8.0%) had MINOCA mimickers. Mimicker patients were significantly younger and had fewer cardiovascular risk factors. True MINOCA was more frequent in females and associated with preserved left ventricular ejection fraction and lower high-sensitivity troponin T levels compared to MI-CAD. CMR and CCTA contributed to etiological clarification in over 70% of MINOCA and mimicker patients. High-risk plaque features were observed in 42.9% of CCTA scans, suggesting but not confirming an atherosclerotic mechanism. Long-term all-cause mortality in MINOCA was similar to MI-CAD (32.1% vs. 30.9%, = 0.764) and significantly higher than in mimickers (5.9%, < 0.001). True MINOCA is a distinct clinical entity with diagnostic and prognostic implications. Its comparable mortality to MI-CAD highlights the need for accurate diagnosis and targeted secondary prevention strategies.
非阻塞性冠状动脉心肌梗死（MINOCA）是一种异质性临床实体，其病理生理学、治疗方法和预后与阻塞性冠状动脉疾病心肌梗死（MI-CAD）以及MINOCA模仿疾病（如心肌炎或Takotsubo综合征）不同。本研究旨在比较真正的MINOCA、MI-CAD和MINOCA模仿疾病患者的临床特征、影像学表现、管理策略和长期预后。这项回顾性队列研究纳入了2012年至2024年期间在一家三级大学医院因急性心肌梗死（AMI）住院的1596例患者。根据冠状动脉造影和先进的心脏成像，将患者分为真正的MINOCA、MI-CAD或MINOCA模仿疾病患者。数据包括临床和实验室变量、超声心动图、心脏磁共振（CMR）和冠状动脉计算机断层扫描血管造影（CCTA）。使用Cox回归分析全因死亡率。在1596例AMI患者中，111例（7.0%）患有真正的MINOCA，1359例（85.1%）患有MI-CAD，127例（8.0%）患有MINOCA模仿疾病。模仿疾病患者明显更年轻，心血管危险因素更少。与MI-CAD相比，真正的MINOCA在女性中更常见，并且与左心室射血分数保留和高敏肌钙蛋白T水平较低有关。CMR和CCTA在超过70%的MINOCA和模仿疾病患者中有助于病因明确。在42.9%的CCTA扫描中观察到高危斑块特征，提示但未证实存在动脉粥样硬化机制。MINOCA的长期全因死亡率与MI-CAD相似（32.1%对30.9%，P = 0.
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