Clinical Characteristics And Prognosis Of Patients With Non-obstructive Coronary Myocardial Infarction

Objective: By collecting the data of patients with Myocardial infarction with non-obstructive coronary arteries(MINOCA)in our hospital,this paper analyzed the clinical characteristics,possible pathogenesis,treatment status,prognosis and related factors affecting the prognosis of MINOCA patients,so as to guide clinical diagnosis and treatment and improve the prognosis of MINOCA patients.Methods: Retrospective analysis was performed on 162 patients who were initially diagnosed with acute myocardial infarction during emergency coronary angiography in the Chest Pain Center of the Second Affiliated Hospital of Guangxi Medical University from August 2018 to October 2020.18 patients met MINOCA diagnosis and 144 patients had an obstructive myocardial infarction(MICAD)(one patient with incomplete data is excluded).The basic data,clinical features,possible pathogenesis,laboratory examination results,cardiac ultrasound,coronary angiography data and treatment methods are summarized and analyzed.Prognosis are recorded at follow-up.And carry on the related literature research,summarizes the experience.Results: A total of 18 MINOCA patients who met the inclusion criteria and underwent emergency coronary angiography in our hospital in this study,with a incidence rate of about 11.1%.The mean age of onset was(51.33±15.40)years,and the age of onset was younger than that of MICAD group(P<0.05),male to female sex ratio(2:1).NSTEMI was more common in MINOCA patients than in the MICAD group(P<0.05).The possible etiological mechanisms were coronary embolism in 4 cases(22.2%),myocardial bridge in 1 case(5.6%),type2 myocardial infarction in 3 cases(16.7%),including third-degree atrioventricular block in 1 case,preexcitation syndrome in 1 case,and atrial fibrillation in 1 case),myocarditis in 5.6%(1 case),cardiomyopathy in 11.1%(2cases),and unknown causes in 7 cases.Among the patients with unknown causes,5 patients(27.8%)had coronary plaques,and 1 patient with unknown causes was diagnosed as central nervous system vasculitis with secondary eosinophilia,which was normal on coronary angiography.Among the laboratory examination indicators,the rates of AST,LDL-C,CK-MB,troponin T and abnormal wall motion in the MINOCA group were lower than those in the MICAD group(P<0.05).Multivariate Logistic regression analysis showed that age(P=0.007,OR: 1.068,95%CI: 1.018-1.120)was an independent risk factor for non-obstructive coronary myocardial infarction.After discharge,the secondary preventive treatment rate of MINOCA patients is significantly lower than that of MICAD group(P<0.05).The in-hospital mortality rates of MINOCA and MICAD were 11.1% and 6.6%,respectively(P>0.05);The median follow-up time is 16 months.The 16 patients with MINOCA had a good prognosis.Within 6 months,the incidence of MACE events in the MINOCA and MICAD groups are 0% and 9.5%,respectively(P>0.05).Conclusions: 1.The incidence of AMI in MINOCA patients in our hospital is about 11.1%,the onset age is younger than that in the MICAD group,the incidence is more common in males,and NSTEMI is more common than that in the MICAD group.2.MINOCA patients have a variety of pathogenesis,among which coronary embolism and type 2 myocardial infarction are one of the important etiologies.It is very important to clarify the potential etiology and individualized treatment.3.The utilization rate of secondary prevention drugs for coronary heart disease in MINOCA patients was low;The in-hospital mortality of MINOCA patients was similar to that of the MICAD group,and the tendency of MINOCA patients to develop MACE in the short term was lower than that of MICAD patients.