Clinical Comparative Study Of Obstructive Myocardial Infarction And Non-obstructive Myocardial Infarction

Objective:In the past century,especially in the past 50 years,the diagnosis and treatment of Acute Myocardial Infarction(AMI)has developed rapidly in patients with ST-segment Elevation Myocardial Infarction(STEMI).In angiography performed within 4 hours after the onset of chest pain,almost 90% of patients have coronary occlusion,but it is confusing that approximately 10% of coronary angiograms have no significant stenosis.Several large AMI follow-up experiments found that about 1%-13% of AMI did not have coronary occlusion.This finding raises a series of important questions: What is the mechanism of myocardial damage in these patients? What is the difference between these patients and patients with obstructive myocardial infarction? Should they adopt the same clinical treatment strategy? Do patients with non-obstructive atherosclerosis have different pathologies in their pathophysiology and coronary angiography? This series of problems led to the emergence of a new clinical disease,namely,Myocardial Infarction with No Obstructive Coronary Atherosclerosis(MINOCA).These patients are not the same as classic offenders in patients with obstructive myocardial infarction.They have typical angina symptoms and evidence of myocardial ischemia,but they cannot be relieved by stent implantation.Therefore,these patients have treatment and obstructive myocardial infarction.The treatment is not the same.Treatment options for various causes are also different.The current understanding of the prognosis of patients with MINOCA is mainly limited to mortality,and little is known about the clinical features of these patients,such as clinical phenotype,functional status,psychological status and health status.Therefore,we hope that through this research we will try to find out and prevent the risk factors that are more closely related to MINOCA.Methods2110 patients with myocardial infarction in our hospital from January 1,2014 to January 31,2019 were selected as subjects.In the cross-sectional study,120 patients with MINOCA were selected according to the inclusion criteria and screening criteria.In the case of myocardial infarction,1990 patients were obstructive myocardial infarction group.In the case-control study,120 patients with MINOCA were enrolled in the observation group.120 patients with obstructive myocardial infarction were selected as the control group by random number selection.Collect clinical data such as age,gender,hyperlipidemia,history of hypertension,history of diabetes,history of smoking,history of drinking,BMI index,family history of coronary heart disease,history of peripheral atherosclerosis,hyperhomocysteinemia Medical history,multivariate binary logistic regression analysis was used to identify the risk factors of MINOCA.Results1.The general clinical features of MINOCA patients: the incidence of MINOCA in AMI is 5.7%,the average age of MINOCA patients is 58.48±13.07 years old,81 cases are younger than 65 years old,accounting for 67.5%;75 cases are male patients.62.5%,more than female patients;There were 78 cases with BMI>24(overweight),accounting for 65%,and 22 cases with BMI>28(obesity),accounting for 18.3%.The risk factors accounted for 68 cases(56.7%)of high blood pressure history,drinking.History of 56cases(46.7%),smoking history of 48 cases(40%),hyperlipidemia 29 cases(24.2%),coronary heart disease history of 28 cases(23.3%),diabetes history of 25 cases(20.8%),high homotype There were 21 cases(17.5%)of cysteine,17 cases(14.2%)of peripheral vascular plaques,and 11 cases(9.2%)of family history of coronary heart disease.2.Compared with obstructive myocardial infarction,the proportion of male patients in MINOCA was lower,and the difference between the two was statistically significant.The proportion of patients with alcoholic history in MINOCA was higher,and the difference was statistically significant.There was no significant difference in hypertension,smoking,overweight,hyperlipidemia,history of coronary heart disease,family history of coronary heart disease,diabetes,hyper-homocysteinemia,peripheral vascular plaque in obstructive myocardial infarction and MINOCA.3.Multivariate binary logistic regression analysis of the risk factors of myocardial infarction for obstructive myocardial infarction and MINOCA showed: relative to obstructive myocardial infarction,smoking history(OR=1.51,P=0.02),drinking history(OR=2.99,The presence of P = 0.01)has a more significant correlation with MINOCA and is a significant risk factor for MINOCA.Conclusions1.Compared with obstructive myocardial infarction,MINOCA patients have a lower incidence of men.2.Risk factors significantly associated with MINOCA include smoking history and drinking history.