| BackgroundAcute myocardial infarction（AMI）seriously endangers human health.Myocardial infarction with non-obstructive coronary arteries（MINOCA）is not uncommon in acute myocardial infarction.Early diagnosis and clarification of its pathogenesis are crucial for its treatment and prognosis.Although research on this disease has increased in recent years,the research conclusions are still inconsistent,and there are still many uncertainties in its pathogenesis,treatment and prognosis.ObjectiveThe clinical characteristics,potential risk factors,nosocomial prognosis and prognostic factors of nonobstructive coronary myocardial infarction were analyzed retrospectively.MethodsPatients who underwent CAG examination and were diagnosed with acute myocardial infarction from June 2018 to May 2020 in Engineering Research Center of Clinical Data and Sample Database of Cardiovascular Diseases of Henan Province were selected.No significant coronary artery stenosis（stenosis<50%）was found on CAG examination in 49 cases.The ratio of patients with obstructive coronary artery Myocardial infarction（MICAD）to patients with MINOCA was 3:1.A total of 147 patients with MI-CAD were selected by stratified sampling.Clinical data between the two groups were collected.Coronary angiography,etiology,incidence of adverse events during hospitalization,Echocardiography and Carotid Ultrasound and medication at discharge were analyzed in MINOCA patients.The influencing factors of MINOCA were analyzed by binary logistic regression,and Spearman rank correlation was used to analyze the correlation between the indicators with differences in baseline data and Gensini score.Receiver operating characteristic（ROC）curve was used to analyze the diagnostic effect of combined predictors on MINOCA,and P<0.05 was considered statistically significant.Results1.MINOCA coronary angiography analysis showed that the degree of coronary artery stenosis was normal in 28 cases（57.1%）and mildly abnormal in 21 cases（42.9%）.The criminal vessels could not be identified in 24 cases（49.0%）,12 cases（24.5%）of anterior descending branch,3 cases（6.1%）of circumflex branch and 10 cases（20.4%）of right coronary artery.TIMI blood flow grading in MINOCA group was better than that in MICAD group,and the comparison between groups was statistically significant（P<0.001）.2.Etiological analysis of MINOCA:There were 19 cases（38.8%）of unknown etiology,14 cases（28.6%）of coronary artery spasm,5 cases（10.2%）of microvascular lesion,4 cases（8.2%）of myocardial bridge,4 cases（8.2%）of coronary artery embolism,3cases（6.1%）of type 2 myocardial infarction（non-coronary causes）.3.Analysis of echocardiography results of two groups of patients:MINOCA patients with carotid artery plaque formation,carotid artery intimal thickening and poor ventricular segmental wall motion was significantly lower than the proportion of the MI-CAD group（P <0.05）,two groups in the ejection fraction and shortening rate,left ventricular posterior wall thickness and interventricular septum thickness,right ventricular diameter,left ventricular end-diastolic volume,no obvious difference between left atrial diameter（P>0.05）.4.Analysis of adverse events during hospitalization and length of stay in the two groups:The average length of stay in MINOCA group was lower than that in MI-CAD group（P<0.05）.There was no significant difference in in-hospital cardiovascular death,all-cause death,nausea arrhythmia,and heart failure events between the two groups（P>0.05）.5.The use of secondary preventive drugs at discharge in the two groups:The proportion of MINOCA group using dual antiplatelet therapy,diuretics and nitrates was lower than6that of MI-CAD group（P<0.05）,while the proportion of calcium channel blockers was significantly higher than that of MI-CAD group（P<0.001）.There was no significant difference in the proportion of statins,β-blockers,ACEI/ARB,nicordil and trimetazidine between the two groups（P >0.05）.6.Comparing the clinical data of the two groups of patients,the proportion of males,smoking,drinking,the proportion of coronary myocardial bridges and the absolute number of lymphocytes in the MINOCA group were higher than those in the MI-CAD group（P<0.05）,while the previous coronary heart disease,Killip ≥ grade 2 ratio,troponin I,white blood cell count,absolute number of neutrophils,NLR,MLR levels were lower than those in MI-CAD group（P>0.05）.After excluding collinearity between independent variables,univariate and multivariate binary logistic regression analysis showed that age（OR=0.078,95%CI:0.017-0.352,P<0.05）,alcohol consumption（OR=6.062,95%CI:1.944-18.902,P<0.05）,NLR（OR=0.662,95%CI: 0.528-0.831,P<0.05）,coronary myocardial bridge（OR=3.012,95%CI:1.216-7.462,P<0.05）,age and NLR were negatively correlated with the incidence of MINOCA,while coronary myocardial bridge and drinking history were positively correlated with the incidence of MINOCA,which were the risk factors.The ROC curve of the combined predictors was drawn,the area under the curve（AUC）was0.877（95% CI: 0.827-0.928）,and its sensitivity for diagnosing MINOCA was 0.878 and specificity was 0.748.7.The results of Spearman rank correlation analysis showed that white blood cell count（r=0.263,P<0.001）,neutrophil count（r=0.198,P<0.05）,MLR（r=0.154,P<0.05）were significantly associated with Gensini score,respectively Correlation.Conclusions1.Compared with MI-CAD patients,MINOCA patients were characterized by younger age of onset,less myocardial damage,and lower levels of inflammation.2.Age,alcohol consumption,NLR and coronary myocardial bridge were independent influencing factors of MINOCA,among which alcohol consumption and coronary myocardial bridge were risk factors.The coronary myocardial bridge and drinking history increased the risk of MINOCA.3.The majority of MINOCA patients have unknown etiology.compared with MI-CAD patients,the incidence of MACE events during hospitalization has not decreased,which,combined with the out-of-hospital medication,suggests that specific treatment based on etiology is relatively insufficient. |
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