| ObjectivesTo investigate the epidemiology,clinical features,etiology,predictive factors and prognosis of MINOCA in a single-center.MethodsA total of 4874 patients with AMI who underwent coronary angiography from January 1,2013 to December 31,2017 were enrolled.By coronary angiography,232 cases of MINOCA were screened.Patients between with MICAD and MINOCA were enrolled in a 4:1 ratio,and 928 cases of MICAD were enrolled by stratified sampling.The clinical data of the two groups were collected and analyzed.The factors with significant differences were screened by single factor analysis.Then the binary logistic regression analysis was performed on these predictors.Draw the ROC curve.Results1.The total morbidity of MINOCA in Fujian Provincial Hospital from 2013 to 2017 was 4.76%,and the morbidity in each year respectively were 3.15%,4.46%,4.85%,5.89%,and 4.91%.2.There were 122 cases(52.6%)of MINOCA with normal coronary artery and 110cases(47.4%)with mild stenosis.AS for the responsible vessels of MINOCA,157 cases(67.7%)were unknow,the rest of which were left main coronary artery[6 cases(2.6%)],left anterior descending[35 cases(15%)],left circumflex[15 cases(6.4%)] and right coronary artery[19 cases(8.2%)].3.There were 94 cases(40.5%)of MINOCA whose pathogeny were unclear,and other pathogeny were that 39 cases(16.8%)with myocarditis,32 cases(13.8%)with T2 MI,27 cases(11.6%)with coronary artery embolism,21 cases(9.1%)with coronary artery spasm,12 cases(5.2%)with Takotsubo cardiomyopathy and 7 cases(3.0%)with coronary artery dissection.4.Results a statistical difference was found in gender,diabetes history,valvulardisease history,fibrinogen,TnI peak,NT-proBNP,LDH-C,ST segment changes,LVEF,presence of ventricular wall motion disorder and atrial fibrillation history between MINOCA and MICAD.Female proportion,valvular disease and atrial fibrillation history,non-ST segment elevation,LVEF in the MINOCA were relatively high;and diabetes history,presence of ventricular wall motion disorder,fibrinogen,TnI Peak and LDH-C were relatively low in the MINOCA.There was no significant statistical difference among age,systolic blood pressure,diastolic blood pressure,heart rate,first angina,WBC,HGB,hypertension,hyperlipidenmia,stroke and the incidence of myocardial bridge(P>0.05).The ROC curve was drawn by the joint factor.The area under the curve was 0.747(P <0.01,95% CI :0.713-0.782),the sensitivity was 73.2%,and the specificity was 65.3%.5.MACE events and hospitalization days in the two groups: the mortality rate in the MINOCA group was lower than that in the MICAD group,the difference was statistically significant [4(1.7%)vs 39(4.0%),P = 0.048 < 0.05];There were no significant differences in acute heart failure,malignant arrhythmia,recurrent myocardial infarction,and stroke events.The average hospital stay in MINOCA is less than MICAD.Conclusions1.MINOCA is an independent group with potential multiple causes.The total morbidity of MINOCA on my Hospital was 4.76%,2.Female,no history of diabetes,valvular disease,atrial fibrillation History,low fibrinogen,ejection fraction ≥50%,non-ST-segment elevation have predictive value for MINOCA;3.In-hospital mortality and average hospital stay of MONOCA were lower than MICAD. |
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