Relative Researches On The Effect Of Sleep Disorder On The Prognosis Of Myocardial Infarction With Non-obstructive Coronary Arteries

Objective To describe the differences between myocardial infarction with non-obstructive coronary arteries(MINOCA)and myocardial infarction with obstructive coronary arteries(MICAD)as well as to describe the clinical characteristics of the MINOCA population with different sex and ST segment of ECG,then to explore their clinical features and sleep status.We further carry out researches and follow-up for MINOCA patients to explore the impact of sleep disorders on their prognosis,so as to provide certain bases for improving prognosis.Methods In this study,56 patients diagnosed with acute myocardial infarction but with coronary angiography stenosis less than 50%in the first hospital of Jiaxing from June 2020 to September 2021were continuously enrolled as the MINOCA group.According to the principle of no more than 5 days between admission dates,257 patients diagnosed with acute myocardial infarction and accompanied by emergency coronary angiography stenosis greater than or equal to 50%were enrolled as the MICAD group.The general data,laboratory indicters,drug treatment strategies and the incidence of adverse cardiovascular events during hospitalization of the two groups of patients were analyzed,and the Pittsburgh sleep quality index(PSQI)questionnaire was evaluated for all patients.Then to compare the clinical characteristics and sleep status of the two groups.At the same time,the clinical characteristics of MINOCA patients with different gender and different ECG ST-segment manifestations were further analyzed.MINOCA patients were divided into different groups according to the PSQI score,and the clinical characteristics of MINOCA patients with different sleep quality were also analyzed.Follow-up was conducted by telephone or WeChat for 1 year to investigate the effects of sleep disorders on the prognosis of MINOCA patients.Results Compared with MICAD group,MINOCA group had a younger age of onset,a lower proportion of males,and a lower proportion of patients with a history of hypertension,diabetes,hyperlipidemia,hyperuricemia,cerebral infarction,angina pectoris,and PCI.On the laboratory indicators,most patients in the MINOCA group are NSTEMI,with lower levels of troponin I,inflammatory indicators,aspartate aminotransferase,creatinine,lipoprotein a,NT-proBNP,left ventricular end systolic diameter,left ventricular end diastolic diameter and the lower proportion of poor ventricular wall motion as well as carotid plaque formation.The left ventricular short axis shortening rate and left ventricular ejection fraction level were higher.In terms of drug treatment strategies,the MINOCA group had a lower use of antiplatelet aggregation drugs(mainly aspirin,ticagrelor),statins and β-receptor blockers than the MIC AD group.Patients with MINOCA had fewer hospital days,but there was no significant difference in the incidence of adverse cardiovascular events during hospitalization between the two groups.Female MINOCA patients had lower rates of smoking and alcohol consumption than the male,higher neutrophil ratio and higher levels of NT-proBNP,but smaller creatinine,left ventricular posterior wall thickness,left atrial diameter,and aortic root diameter.STEMI in MINOCA patients had higher levels of troponin I,NT-proBNP and left ventricular posterior wall thickness,and lower levels of lipoprotein a and left ventricular short axis shortening than NSTEMI patients.After scoring all patients with PSQI questionnaire,we found that the proportion of sleep disorders in MINOCA group was higher than that in MIC AD group,with 82.14%and 70.04%,respectively.Therefore,the second part of this study conducted further researches and follow-up on patients with MINOCA,we found that there were differences in the number of diseased vessels between patients with mild sleep disorders and patients with severe sleep disorders.Although there was no significant difference in baseline lipid indicators among patients in each group,1-year follow-up showed that sleep status can influence some lipid outcomes.There were no statistically significant differences in the primary outcome(the rate of major adverse cardiovascular events)between the non-sleep disorders group and the sleep disorders group,but the rate of recurrent chest pain of varying degrees or readmission to hospital due to cardiovascular events was higher in the latter,thus indicating sleep disorders was a risk factor for poor prognosis in MINOCA patients.Conclusion The average age of MINOCA patients was younger,lower proportion of the male,with relatively fewer complications in the past and better indicators reflecting cardiac injury.Due to the mild coronary angiography vascular lesions,only some patients received standardized secondary prevention drugs for coronary atherosclerotic heart disease.And the clinical characteristics of MINOCA patients with different genders and ECG ST-segment manifestations were different.In addition,MINOCA had a higher rate of sleep disorders than MICAD.Follow-up of MINOCA showed that patients with sleep disorders had a higher incidence of secondary prognostic end points,and sleep status could affect some blood lipids,indicating that sleep disorders were one of the adverse prognostic factors.