Clinical Analysis Of Non-obstructive Coronary Artery Disease

Objective: To investigate the clinical characteristics of patients with non-obstructive coronary artery disease(NOCAD)in a single-center.Methods: 23 patients who suffered from myocardial infarction with non-obstructive coronary arteries(MINOCA)and 33 patients with ischemia and no-obstructive coronary artery disease(INOCA)form January 2017 to December 2019 in Hospital were enrolled as the observation group.24 patients with chest pain and exclusion of coronary artery disease were randomly selected as the control group.The general clinical data,laboratory and echocardiographic indexes,and medication history during hospitalization were compared among the three groups.The coronary angiography of MINOCA group was analyzed and the culprit vessel of NOCAD were judged.Results: There was no significant difference in body mass index,history of hypertension,history of diabetes,hyperlipidemia and history of cerebral infarction among the three groups(P>0.05).The proportion of smoking in MINOCA group was higher than that in control group(P< 0.001)and INOCA group(P<0.003).The white blood cell count and neutrophil count in MINOCA group were higher than those in control group(P=0.001,P=0.001)and INOCA group(P=0.009,P<0.001).Compared with the control group,MINOCA group had increased monocyte to high-density lipoprotein cholesterol ratio(P=0.039).The levels of total protein and albumin in MINOCA group were lower than those in control group(P<0.001,P=0.002)and INOCA group(P=0.016,P=0.045).Compared with the control group,INOCA patients had increased levels of glutamyltransferase(P=0.037).Coronary angiography was performed in 23 patients with MINOCA,including8 cases of contrast medium retention,7 cases of coronary artery spasm,6cases of spontaneous recanalization,1 case of myocardial bridge and 1 case of coronary slow flow combined with coronary artery tortuosity.The number of anterior descending artery lesions in MINOCA and INOCA patients was 14(60.9%)and 22(66.7%),respectively.The diseased vessels of 5 patients with MINOCA were right coronary artery,of which 4 cases showed coronary artery spasm.Conclusions:1.The incidence of NOCAD patients complicated by traditional cardiovascular risk factors(obesity,hypertension,diabetes and hyperlipidemia)is similar to that of the control group.2.Smoking,inflammatory status,and reduced albumin are risk factors for MINOCA;increased glutamyltransferase is risk factor of INOCA.3.Coronary angiography of patients with MINOCA shows several situations,including contrast medium retention,coronary artery spasm,spontaneous recanalization,myocardial bridge,coronary slow flow and coronary tortuosity.4.MINOCA and INOCA vascular lesions often occur in the anterior descending artery;coronary artery spasm may occur in the right coronary artery.