Risk Factors And Prognostic Analysis Of Myocardial Infarction With Non-obstructive Coronary Arteries (MINOCA)

Objective: This article retrospectively studied the risk factors of coronary non-obstructive myocardial infarction(MINOCA)and related factors affecting prognosis,which caused the attention of clinicians and improved the prognosis of patients with MINOCA.Materials and Methods: From January 2016 to December 2017,in the 1905 patients who were diagnosed with acute myocardial infarction and underwent coronary angiography in the chest pain center of Quanzhou First Hospital,42 patients who met the MINOCA diagnostic criteria were screened.General information,symptoms and signs,past history,laboratory tests,cardiac ultrasound,electrocardiogram,coronary angiography,treatment outcome,and prognosis were summarized.Pearson correlation analysis was used to derive risk factors for endpoint events,and logistic regression analysis was used to obtain independent predictors of composite endpoint events(thoracic pain re-admission/infarction recurrence).The chi-square test was used to analyze the difference in risk factors between the STMEI and NSTEMI subgroups in MINOCA.Results1、 General clinical features of MINOCA patients: A total of 42 MINOCA patients were included in the study.The cause included 54.7%(23 cases),rupture of plaque 19.0%(8 cases),coronary artery ridge 4.8%(2 cases),spontaneous coronary dissection 2.4%(1 case),coronary embolism 14.3%(6 cases).Example),myocardial bridge 4.8%(2 cases).The average age of onset was(56.78±13.91)years old,57.1%(24 cases)with hyperuricemia,47.6%(20 cases)with hypertension,and 52.4%(22 cases)with smoking history..In the CAG angiography,the vascular stenosis accounted for 76.2%(32 cases),and the TIMI blood flow ≤2 level was 4.8%(2 cases).During the follow-up period,a total of 6 patients(14.3%)were admitted to the hospital due to recurrent heart disease/chest pain.One(2.4%)had a myocardial infarction and five patients(11.9%)were re-admitted due to chest pain.In the application of drug treatment after discharge,the application rate of aspirin and P2Y12 inhibitors was 73.8%(31 cases),and the statin application rate was 90.5%(38 cases),which did not reach the drug treatment routine of coronary heart disease.2、 One-year event and related predictive factors of MINOCA patients after discharge: According to Pearson correlation analysis,the independent variables were selected,and the composite end point event was set as the dependent variable.Logistic regression analysis was performed to obtain cerebrovascular disease and statin therapy.Is an independent predictor of MINOCA composite endpoint events.3、 Comparison of risk factors and prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in MINOCA patients:(1)The incidence of STEMI in 1MINOCA patients was 54.8%(23 cases)higher than 45.2%(19 cases)in NSTEMI.In both groups,NSTEMI patients had a lower onset age than STEMI patients(P = 0.07),and NSTEMI patients had a higher rate of diabetes(P = 0.001)compared with STEMI patients.(2)In laboratory biochemical indicators,myocardial enzyme marker AST was significantly higher in STEMI than NSTEMI(P=0.026),BNP in NSTEMI patients was significantly higher than STEMI(P=0.023),and STEMI vascular stenosis was shown in CAG test results(0 < stenosis diameter < 50%)73.9%(17 cases),NSTEMI vascular stenosis accounted for 78.9%,there was no statistically significant difference between the two groups(P = 0.170).(3)Cardiac color Doppler examination showed that the proportion of wall motion abnormalities in STEMI was significantly higher than that in the NSTEMI group(P=0.001).(4)In the drug treatment during hospitalization,the NSTEMI group used statins and beta blockers more than STEMI(P ≤ 0.05).In post-discharge treatment,the use of nicorandil in the NSTEMI group was significantly higher than that in the STEMI group.(P = 0.01).(5)At 1 year follow-up after discharge,the composite end point was 17.4%(4 cases)in the STEMI group,including 4.3%(1 case)of recurrent myocardial infarction,13.0%(3 cases)of chest pain re-admission,and a composite endpoint in the NSTEMI group.10.5%(2 cases),2 cases were admitted to hospital with chest pain.There was no significant difference in the incidence of composite endpoint events between the two groups(P = 0.211).Comclusion1.Although the prevalence of MINOCA is low,it also has certain clinical features.Males have multiple symptoms。2.The risk factors associated with MINOCA are roughly the same as those of coronary artery obstructive myocardial infarction.3.combined with cerebrovascular disease,statin is an independent predictor of composite end point events,suggest that clinicians should pay attention to the control of risk factors and antithrombotic and statin applications.4.The incidence of STEMI in patients with MINOCA was higher than that in NSTEMI.There was no significant difference in the prognosis between STEMI and NSTEMI.5.Although MINOCA patients do not have significant vascular stenosis,they often have different degrees of myocardial damage,and their long-term prognosis bias should be highly valued in clinical work.