Analysis Of Clinical Characteristics And In-hospital Death About Myocardial Infarction With Non-obstructive Coronary Arteries

BackgroundCoronary artery disease(CAD)is the most common cause of death and disability in China,acute myocardial infarction(AMI)is the most severe form of CAD.As a special type of AMI,myocardial infarction with non-obstructive coronary arteries(MINOCA)has complex etiology and varied clinical features.It is often misdiagnosed as unstable angina pectoris,or diagnosed as non-ST-segment elevation myocardial infarction(NSTEMI)roughly,and the prognosis of MINOCA is also mistaken for superior than that of myocardial infarction with obstructive coronary artery disease(MI-CAD).Novel biomarkers play an important role in the development and prognosis of CAD,for example,neutrophil count/lymphocyte count(NLR),monocyte count/high density lipoprotein count(MHR)are associated with infarction size and short-term prognosis in AMI patients,but the association with MINOCA remains to be explored.We aimed to analyze the difference of clinical characteristics and the outcome of in-hospital mortality between MINOCA and MI-CAD,as well as the factors related to MINOCA,and the predictive indicators of in-hospital death among AMI patients.MethodsWe used a retrospective analysis of group cases and collected the clinical data of AMI patients admitted to Qilu Hospital of Shandong University from January 2017 to May 2021 who underwent coronary angiography.They were divided into MINOCA group and MI-CAD group according to the degree of coronary stenosis<50%or≥50%.Baseline clinical characteristics were collected and compared between the two groups.Logistic regression analysis was used to screen the related factors of MINOCA,and subgroup analyses were conducted with different genders,different ST segment changes in electrocardiogram(ECG),the presence or absence of hyperlipidemia,and different renal function.The predictive factors of in-hospital death among AMI patients were investigated by restricted cubic spline curve and Logistic regression analysis.ResultsThe study enrolled 3048 AMI patients,including 165 patients(5.4%)in the MINOCA group and 2883 patients(94.6%)in the MI-CAD group.Compared with MI-CAD patients,MINOCA patients were younger,more female,had a higher incidence NSTEMI,and had a lower history of smoking,diabetes,CAD and myocardial infarction.Novel inflammatory biomarkers such as NLR and MHR were lower,creatinine,N-terminal pro-B-type natriuretic peptide(NT-proBNP),creatine kinase-MB,high sensitivity-troponin I(hs-cTnT),fibrinogen,fasting blood glucose levels were lower,high-density lipoprotein cholesterol was higher(P<0.05);and the incidence of myocardial bridge,arrhythmia(tachycardia and atrial fibrillation)was higher(P<0.05).The application rates of calcium channel blocker(CCB)and new-oralanticoagulants(NOAC)were higher(P<0.05),and there was no statistical difference in hospitalization days and in-hospital death(P>0.05).Multiple Logistic regression analysis showed that age[OR:0.954,95%CI(0.939,0.970),P<0.001],female[OR:1.678,95%CI(1.060,2.657),P=0.027],the history of smoking[OR:0.634,95%CI(0.415,0.969),P=0.035],the history of CAD[OR:0.288,95%CI(0.169,0.492),P<0.001]and MHR[OR:0.224,95%CI(0.095,0.529),P=0.001]were associated with MINOCA.The AMI patients with a history of CAD[OR:2.421,95%CI(1.186,4.944),P=0.015]and chronic renal failure[OR:7.008,95%CI(2.667,18.415),P<0.001],higher fasting blood glucose[OR:3.417,95%CI(1.425,8.189),P=0.006],higher NLR[OR:1.100,95%CI(1.032,1.173),P=0.004],and higher D-dimer[OR:1.545,95%CI(1.053,2.267),P=0.026]were more likely to correlated with in-hospital death.MINOCA was not associated with a reduction in the inhospital death in AMI patients[OR:0.237,95%CI(0.021,2.668),P=0.244].ConclusionsCompared with MI-CAD patients,MINOCA patients were younger,female,had no history of smoking or CAD,and had a lower baseline MHR levels,the application rate of CCB and NOAC was higher.MINOCA was often associated with myocardial bridge and atrial fibrillation.The incidence of in-hospital death in MINOCA patients was not significantly different from that in MI-CAD patients,AMI patients with the history of CAD or chronic renal failure,the higher level of NLR,d-dimer and fasting blood glucose were more likely to occur death in hospital.