Clinical Features,risk Factors And Prognosis Of Myocardial Infarction With Non-obstructive Coronary Arteries

Background: Myocardial infarction with non-obstructive coronary arteries(MINOCA)is a special type of myocardial infarction without obvious coronary artery stenosis.At present,there are still many unknown and controversial studies on the etiology,risk factors and prognosis of MINOCA patients.Due to the lack of research on the clinical characteristics of different genders of MINOCA,there is no evidence-based medicine evidence,it is currently unclear whether gender differences in the clinical characteristics and risk factors of coronary heart disease also exist in MINOCA.Objective: Part one: To explore the clinical features,potential etiology,prognosis and prognostic factors of patients with MINOCA.Part two: The clinical characteristics and risk factors of MINOCA patients of different genders were compared by Meta analysis.Methods: Part one: This study was an observational clinical study.A total of 104 patients with MINOCA who met the inclusion criteria in the first affiliated Hospital of Dali University and the people’s Hospital of Dali Prefecture from January 2018 to December 2021 were included in the observation group.According to the admission time of MINOCA patients ± 5 days,104 patients with obstructive myocardial infarction(MI-CAD)were randomly selected as the control group at 1:1.The median follow-up period was 18 months.Major adverse cardiovascular events(MACE)were taken as the end point of the study.The baseline data,coronary angiography-derived index of microvascular resistance(ca IMR),coronary angiography results,treatment and prognosis were compared between the two groups.Multivariate COX regression,binary Logistic regression,Kaplan-Meier curve and ROC curve were used to analyze survival and evaluate the predictive value.Part two: Search the clinical studies of different genders of MINOCA patients in Pub Med,Embase,Web of science and other databases before December 2022,and analyze the data extracted by Rev Man5.4 software.Results:1.General clinical features: MINOCA is in 2.6% of all patients with myocardial infarction.Compared with MI-CAD group,MINOCA patients had lower age,higher proportion of female,lower proportion of hypertension,hyperuricemia,positive family history and cerebrovascular accident history,Killip grade and higher proportion of NSTEMI and atrial fibrillation,the differences were statistically significant(P<0.05).In blood test and cardiac color ultrasound,compared with MI-CAD group.Neutrophil count,ratio of neutrophils to lymphocytes(NLR),ratio of neutrophils to albumin,ratio of neutrophils to high density lipoprotein cholesterol,total cholesterol,triglyceride,low density lipoprotein cholesterol,apolipoprotein B,D-dimer,NT-pro BNP,BNP,c Tn I peak,fibrinogen and prothrombin time are lower in patients with MINOCA.Platelet,high density lipoprotein cholesterol and apolipoprotein A1 were higher,left ventricular end diastolic and systolic diameters were lower,and the proportion of impaired wall motion was lower,the difference was statistically significant(P<0.05).Compared with MI-CAD group,the utilization rate of double antiplatelet drugs,ADP receptor antagonists and β receptor blockers in MINOCA group was significantly lower than that in MINOCA group(P<0.05).In the results of coronary angiography,compared with MI-CAD group,the proportion of coronary plaque was less and the proportion of slow coronary flow was higher in MINOCA group,and the difference was statistically significant(P<0.001).2.Multivariate Logistic regression analysis showed that young age,female,NSTEMI,no hypertension or hyperuricemia,no impaired wall motion and low LDL-C were more likely to cause MINOCA.COX multivariate regression analysis showed that the ratio of platelet to lymphocyte(PLR)was an independent risk factor for the poor prognosis of MINOCA patients(HR = 1.018,95% CI: 1.006-1.03,P = 0.003).In binary Logistic analysis,it was found that ca IMR was an independent predictor of MACE(OR= 1.095,95% CI: 1.018-1.178,P = 0.015).ROC curve shows that PLR and ca IMR have good ability to predict MACE of MINOCA patients(the area under the curve is 0.77 and 0.79 respectively).3.Malignant arrhythmia and hospitalization days in MINOCA group were lower than those in MI-CAD group,and the difference was statistically significant.After a median follow-up of 18 months,the incidence of MACE in MINOCA group and MICAD group after discharge was 17.5% and 25.0%,respectively,with no statistical significance(P=0.236).4.There were 8 documents that met the requirements,including 19,998 females and 14,510 males.There were more females complicated with hypertension,diabetes,hyperlipidemia,chronic lung disease and NSEMI than males,and the difference was statistically significant.There was no statistical difference in the proportion of atrial fibrillation and the level of left ventricular ejection fraction between the two groups(P>0.05).Conclusion:1.Compared with MI-CAD,MINOCA has lower prevalence rate,younger onset age,more females,fewer risk factors for coronary heart disease,lower inflammatory index,frequent slow coronary blood flow and atrial fibrillation,and less use of secondary preventive drugs for coronary heart disease.2.Elevated ca IMR and PLR are independent risk factors for poor prognosis of MINOCA patients.3.Compared with MI-CAD patients,MINOCA patients have a slightly better in-hospital prognosis.However,the incidence of MACE in long-term MINOCA group is similar to that in MICAD group.4.The clinical features and risk factors of MINOCA patients of different sexes are different.Among MINOCA patients,the incidence of women is higher and older,and the incidence of NSTEMI is higher,which is more likely to be complicated with risk factors of coronary heart disease and chronic lung disease.