Mantzouranis Emmanouil, Leontsinis Ioannis, Vlachakis Panayotis K, Mihas Constantinos, Iliakis Panagiotis, Dri Eirini, Sakalidis Athanasios, Soulaidopoulos Stergios, Fragoulis Christos, Milkas Anastasios, Tsiamis Eleftherios, Tsiachris Dimitrios, Dimitriadis Kyriakos, Tsioufis Konstantinos
First Department of Cardiology, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, Vas. Sofias 114, 11527 Athens, Greece.
Athens Naval Hospital, 11521 Athens, Greece.
J Clin Med. 2025 Jun 5;14(11):3984. doi: 10.3390/jcm14113984.
Large clinical trials have established the optimal antiplatelet strategy in the wide spectrum of coronary artery disease. However, data are scarce regarding MINOCA and the aim of our study is to present data from the current clinical practice. : A total of 151 patients were included in this study after exclusion of 27 patients with myocarditis and other diagnoses. A cardiac magnetic resonance (CMR) performed at 123/151 patients demonstrated an ischemic pattern of late gadolinium enhancement (LGE) confirming the diagnosis of true acute myocardial infarction (AMI) in 42 cases (28%). Based on multimodality imaging and clinical judgement, Takotsubo syndrome (TTS) was diagnosed in 55 patients (36%), whereas CMR failed to reveal abnormal findings in 54 cases (36%), categorized as MINOCA of unknown origin. : Regarding antithrombotic prescriptions at discharge, 38% of patients received dual antiplatelet (DAPT) or dual antithrombotic therapy (DAT, 1 antiplatelet plus 1 anticoagulant), 49.7% received single antiplatelet (SAPT) or anticoagulant, and 12% received no antithrombotic treatment. Univariate analysis showed that the likelihood of prescribing DAPT or DAT was associated with left ventricular ejection fraction (LVEF) (r = 0.202, = 0.013), atherosclerotic lesions on coronary angiography (r = 0.303, < 0.001), prior use of anticoagulants (r = -0.258, = 0.001), and marginally with the INTERTAK score (r = -0.198, = 0.044). A multivariable model, adjusted for age, LVEF, ECG abnormalities, and history of anticoagulant use, confirmed the independent association between angiographic evidence of atherosclerosis and the decision for DAPT/DAT (OR: 0.334, 95% CI: 0.307-0.813, < 0.001). However, the initial treatment decision did not seem to impact 2-year prognosis in our population. : Our study results reveal that decision making in the antithrombotic strategy for MINOCA patients poses a challenge in clinical practice. More robust data are required for definite conclusions on the prognostic implications.
大型临床试验已确立了广泛冠状动脉疾病中的最佳抗血小板策略。然而，关于心肌梗死伴非阻塞性冠状动脉病变（MINOCA）的数据却很稀少，我们研究的目的是展示当前临床实践中的数据。本研究共纳入151例患者，排除了27例患有心肌炎和其他诊断的患者。123/151例患者进行的心脏磁共振成像（CMR）显示出晚期钆增强（LGE）的缺血模式，证实42例（28%）为真正的急性心肌梗死（AMI）。基于多模态成像和临床判断，55例患者（36%）被诊断为应激性心肌病（TTS），而54例（36%）CMR未发现异常，归类为不明原因的MINOCA。关于出院时的抗栓处方，38%的患者接受双联抗血小板（DAPT）或双联抗栓治疗（DAT，1种抗血小板加1种抗凝剂），49.7%的患者接受单联抗血小板（SAPT）或抗凝剂，12%的患者未接受抗栓治疗。单因素分析显示，开具DAPT或DAT的可能性与左心室射血分数（LVEF）相关（r = 0.202，P = 0.013）、冠状动脉造影上的动脉粥样硬化病变相关（r = 0.303，P < 0.001）、既往使用抗凝剂相关（r = -0.258，P = 0.001），与INTERTAK评分有边际相关性（r = -0.198，P = 0.044）。一个针对年龄、LVEF、心电图异常和抗凝剂使用史进行调整的多变量模型，证实了动脉粥样硬化的血管造影证据与DAPT/DAT决策之间的独立关联（OR：0.334，95%CI：0.307 - 0.813，P < 0.001）。然而，初始治疗决策似乎并未影响我们研究人群的2年预后。我们的研究结果表明，MINOCA患者抗栓策略的决策在临床实践中是一项挑战。需要更有力的数据才能得出关于预后影响的确切结论。
