| Objective:The incidence of coronary non-obstructive myocardial infarction(MINCOA)is increasing year by year,and its treatment focuses on prevention and early detection.There are no uniform prevention and treatment protocols for patients with MINCOA.Therefore,a meta-analysis of the clinical characteristics of patients with MINCOA was conducted to find controllable factors to prevent the occurrence of MINCOA,to identify the occurrence of MINCOA at an early stage,and to provide evidence-based medical evidence for clinical intervention and the development of effective and standardised treatment protocols.Methods:Computer searches of databases such as China Knowledge Network,Wanfang database,Vipshop database,CBM,Pub Med,Web of Science and Cochrane Library were conducted to collect relevant research literature on clinical characteristics of patients with coronary non-obstructive myocardial infarction published at home and abroad since the establishment of the database.Eligible articles were screened by 2 researchers according to inclusion and exclusion criteria.The quality of the literature was evaluated using the Newcastle-Ottawa Scale(NOS)quality assessment form.The data were processed and analysed by the software Revman 5.4,and publication bias analysis was carried out using both Revman 5.4 and Stata 16.0.Results:An initial literature search of 495 articles resulted in the inclusion of 11 articles,with a total of 7615 patients with MINOCA and 170,910 patients with MIOCA.Meta-analysis showed that: compared to MIOCA patients,MINOCA patients were more likely to be female[OR=2.28,95%CI(1.77,2.94),P<0.00001] and less likely to have a combined smoking history[OR=0.61,95%CI(0.58,0.64),P<0.00001];a subgroup analysis of age showed that patients in the Chinese group with MINOCA were younger than those in the MIOCA group[SMD=-0.45,95%CI(-0.52,-0.37),P<0.00001],and patients in the non-Chinese group with MINOCA were similarly younger than those in the MIOCA group[SMD=-0.12,95%CI(-0.14,-0.09),P<0.00001].Compared to patients with MIOCA,patients with MINOCA tend to have a combination of atrial fibrillation[OR=1.65,95%CI(1.13,2.42),P=0.01] and less often diabetes[OR=0.66,95%CI(0.52,0.83),P=0.00005],hyperlipidaemia[OR=0.69,95%CI(0.66,0.73),P<0.00001] and coronary artery disease[OR=0.41,95%CI(0.31,0.55),P<0.00001].Compared to the MIOCA group,patients in the MINOCA group had a high mean heart rate[SMD=0.24,95%CI(0.05,0.43),P=0.01],mostly NSTEMI[OR=2.64,95%CI(2.26,3.09),P<0.00001],few pathological Q waves[OR=0.54,95%CI(0.34,0.85),P=0.007],low LDL-C levels [SMD=-0.30,95%CI(-0.37,-0.22),P<0.00001]and high HDL-C[SMD=0.45,95%CI(0.31,0.58),P<0.00001] and LVEF levels[SMD=0.30,95%CI(0.15,0.45),P<0.0001].Compared to the MIOCA group,MINOCA patients had lower rates of heart failure[OR=0.46,95%CI(0.32,0.66),P<0.0001],cardiovascular death[OR=0.73,95%CI(0.59,0.89),P=0.002],all-cause death[OR=0.75,95%CI(0.62,0.91),P=0.004] and MACE within 1 year of hospitalisation[OR=0.66,95%CI(0.49,0.88),P=0.005],and higher rates of stroke within 1 year[OR=1.23,95%CI(1.02,1.49),P=0.03].There were no statistically significant differences in BMI[SMD=-0.10,95%CI(-0.25,0.04),P=0.16],family history of cardiovascular disease[OR=0.82,95%CI(0.53,1.28),P=0.38],history of hypertension[OR=0.91,95%CI(0.79,1.04),P=0.17],or history of cerebral infarction[OR=0.71,95%CI(0.38,1.34),P=0.29] between patients in the MIOCA and MINOCA groups;there were no statistically significant differences in TC[SMD=-0.14,95%CI(-0.31,0.02),P=0.09],TG[SMD=-0.08,95%CI(-0.26,0.09),P=0.33],fasting glucose[SMD=-0.24,95%CI(-0.53,0.06),P=0.12],or C-reactive protein levels[SMD=-0.08,95%CI(-0.22,0.05),P=0.22] between the two groups;there were also no statistically significant differences in in-hospital malignant arrhythmias[OR=0.89,95%CI(0.50,1.58),P=0.69],in-hospital target vessel lesion revascularization[OR=0.25,95%CI(0.01,5.40),P=0.38],cardiovascular death within 1 year[OR=0.67,95%CI(0.38,1.19),P=0.18],or recurrent myocardial infarction within 1 year [OR=0.61,95%CI(0.28,1.30),P=0.20]between the two groups.Conclusion:1.MINOCA patients are more likely to be female,more likely to have atrial fibrillation,less likely to have smoking,diabetes,hyperlipidaemia,coronary artery disease,female,atrial fibrillation can be considered as risk factors.2.Subgroup analysis showed that patients in the Chinese group with MINOCA were younger than those in the MIOCA group,and patients in the non-Chinese group with MINOCA were also younger than those in the MIOCA group.3.Patients with MINOCA have a faster mean heart rate compared to those with MIOCA,tend to have non-ST-segment elevation myocardial infarction,are less likely to have pathological Q waves and have a high left ventricular ejection fraction on cardiac ultrasound.4.MINOCA patients had low LDL-C levels and high HDL-C levels,but there were no significant differences in TC,TG,C-reactive protein and fasting glucose levels between the two groups.5.MINOCA patients have a lower incidence of heart failure,cardiovascular death and all-cause death during hospitalisation,a lower incidence of MACE at 1 year and a higher incidence of stroke at 1 year than MIOCA patients.6.There were no statistically significant differences between the two groups for BMI,family history of cardiovascular disease,hypertension,previous cerebral infarction,in-hospital malignant arrhythmia,in-hospital target vessel lesion revascularisation,cardiovascular death within 1 year and recurrent myocardial infarction within 1 year. |
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