| Objective:In this study,we retrospectively analyzed the clinical data and the occurrence of adverse events after discharge in 196 patients whose coronary angiography suggested non-obstructive coronary artery(normal coronary artery or stenosis <50%)for acute myocardial infarction,The clinical characteristics,prognosis and the risk factors of patients with myocardial infarction with non-coronary arteries(MINOCA)and its subgroups(STEMI group and NSTEMI group)were analyzed to provide reference for clinical work.Methods:The enrolled patients were 196 patients who were diagnosed as MINOCA from January 2015 to July 2018 in the First Hospital of Jilin University.The patient’s baseline clinical data,the medication usage during hospitalization and the occurrence of adverse events after discharge were collected.Statistical analysis was performed using SPSS25.0 software.Continuous variables were evaluated using T test or non-parametric test,Categorical variables were evaluated using the chi-square test,Fisher’s exact test and the log-rank test.Binary Logistic regression analysis was used to evaluated the independent risk factors of poor prognosis in patients with MINOCA and its subgroups.Results:1.The overall clinical characteristics of MINOCA patients: A total of 196 MINOCA patients(2.02%)were included in this study,of which 71.9% were male(141cases)and 28.1% were women(55 cases).The average age of onset was 54.65±11.66 years.The number of days in hospital was 6(4,8).Among the risk factors for coronary heart disease,11.7%(23 cases)with diabetes,48.5%(95 cases)with hypertension,28.6%(56 cases)with hyperlipidemia,8.2%(16 cases)with arrhythmia and 68.9%(135cases)with a history of smoking.There were 14.8%(29 cases)of patients with Killip grade ≥ 2 at the time of admission.2.Prognosis and related risk factors of MINOCA patients: During the follow-up period,a total of 46 patients(23.47%)had 51 adverse events.Binary logistic multivariate regression analysis showed that the patient’s age older than 50 years(HR3.318,Cl 95%: 1.123-9.805,P=0.030)and Killip grade ≥ grade 2(HR 3.053,Cl 95%:1.138-8.189,P= 0.027)were independent risk factors for poor prognosis in MINOCA patients,and the use of β-blockers during hospitalization(HR 0.399,Cl 95%: 0.177-0.902,P=0.027)was an independent protective factor for poor prognosis.In addition,the survival rate of male patients was higher than that of female patients,and the difference was statistically significant(Log-rank P=0.033);Killip≥2 was associated with lower survival rate(Log-rank P=0.013).3.Comparison of clinical features and prognosis between subgroups in MINOCA(STEMI group and NSTEMI group):(1)General information: Among MINOCA patients,the incidence of STEMI was58.7%(115 cases)higher than 41.3%(81 cases)of NSTEMI.The onset age of STEMI patients was lower than NSTEMI patients(52.93±12.68 VS 56.47±11.21,P=0.045).Compared with STEMI patients,the proportion of NSTEMI patients with hypertension and a higher killip grade was higher(P<0.05).In terms of drug use during hospitalization,STEMI group used aspirin more than the NSTEMI group(97.39% VS90.12%,P=0.018),but there was no significant difference in the treatment of Y2P12 blockers,β-blockers,and statins(P>0.05).(2)Laboratory indicators: Compared with the STEMI group,the NSTEMI group had lower levels of prothrombin time,AST,and ALT,while the fasting blood glucose level was higher.The difference between the groups was statistically significant(P<0.05).(3)Prognosis: During the 49(37,61)months of follow-up,the adverse events in the STEMI group was 24.35%(28 cases),including admission to hospital for recurring chest pain 3.48%(4 cases)and recurring myocardial infarction 2.61%(3 cases),heart failure 12.17%(14 cases),stroke 4.35%(5 cases),death 4.35%(5 cases);adverse events in the NSTEMI group were 22.22%(18 cases),incliding admission to hospital for recurring chest pain 4.94%(4 cases),recurring myocardial infarction 2.47%(2cases),heart failure 9.88%(8 cases),stroke 3.70%(3 cases),heart valve replacement2.47%(2 cases),death 1.23%(1 case),there was no statistically significant difference in the incidence of adverse events between the subgroups(P>0.05).(4)Related risk factors of poor prognosis in subgroups: Binary Logistic multivariate regression analysis showed that low-density lipoprotein(HR 3.269,Cl95%: 1.219-8.764,P=0.019)was an independent risk factor for poor prognosis in STEMI patients.The use of β-blockers during hospitalization(HR 0.178,Cl 95%:0.045-0.700,P=0.013)was an independent protective factor for the poor prognosis of STEMI patients;β-blockers used during hospitalization(HR 0.303,Cl 95%: 0.093-0.991,P=0.048)was also a protective factor for poor prognosis of NSTEMI patients.Conclusion:1.The prevalence of MINOCA was low,and it is more common in male patients.The combined risk factors of coronary heart disease were smoking history,history of hypertension,hyperlipidemia,diabetes,and arrhythmia.2.The incidence of prognostic adverse events in MINOCA was relatively high.Age ≥50 years and Killip grade ≥2 were independent risk factors for poor prognosis,and the use of β-blockers during hospitalization was an independent protective factors for poor prognosis.3.The proportion of STEMI in MINOCA patients was higher than NSTEMI,and there was no significant difference in the incidence of adverse events(admission to hospital for recurring chest pain,recurring myocardial infarction,heart failure,stroke,and death)between the two subgroups(P>0.05).4.Different risk factors for poor prognosis in STEMI and NSTEMI groups: Lowdensity lipoprotein was an independent risk factor for poor prognosis in STEMI group,and the use of β-blockers during hospitalization could reduce the risk of adverse events during follow-up in STEMI and NSTEMI groups. |
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