| Objectives1.To analyze the clinical characteristics of MINOCA and AMI-CAD,and to establish a prediction model to identify the occurrence of MINOCA;2.To identify the independent risk factors associated with in-hospital MACE events in MINOCA;3.To find the MI-CAD nosocomial MACE events related independent risk factors.MethodsPatients with acute myocardial infarction who underwent CAG in Dalian Central Hospital from July 2016 to June 2022 were collected.A total of 87 patients with MINOCA were enrolled.With year and department as stratification standard,489 patients with MI-CAD were collected according to the ratio of MINOCA to MI-CAD1:5.6.Baseline data,biochemical indicators,electrocardiogram,echocardiography,and CAG and PCI results within 24 hours of admission were collected from the two groups of patients.Through univariate analysis,the statistically significant indicators were analyzed by binary logistic regression analysis to obtain the identification factors of MINOCA and MI-CAD.The patients were divided into subgroups according to whether in-hospital MACE events occurred,and the predictive factors of in-hospital MACE events in different types of myocardial infarction subgroups were analyzed respectively.Results1.There were significant differences in the following aspects between MINOCA and MI-CAD groups(p<0.05): Baseline data: gender,age,length of hospital stay,history of hypertension,diabetes,coronary heart disease and atrial fibrillation;Echocardiography: whether there is abnormal ventricular wall contraction and ventricular aneurysm;In the intervention method: whether to take emergency CAG;ECG: Whether the ST segment elevation and premature ventricular contraction were present;Serological indicators: The measurement values of ALT,AST,FBG,BUN,Scr,UA,Hcy,CK-MB,CK,hs-c Tn T,N,Hb,APTT,TT;In terms of medication: aspirin,warfarin,ticagrelor,statins,ACEI/ARB,beta blockers,CCB,the use of diuretics.2.There was no significant difference in in-hospital MACE events between MINOCA group and MI-CAD group(5(5.7%)vs 39(8.0%),P=0.465).3.Gender(female)(P<0.001,95%CI 2.322～18.555),history of atrial fibrillation(P=0.001,95%CI 2.413～35.110),premature ventricular contraction on ECG(P=0.051,95%CI 0.986～135.479)were independent risk factors for MINOCA and may be a predictor of MINOCA occurrence;Elderly(P < 0.001,95%CI 0.888～0.967),FBG(P=0.006,95%CI 0.590～0.915),echocardiography suggesting abnormal ventricular wall contraction(P=0.043,95% CI 0.155～0.972)and higher hs-c Tn T(P=0.010,95% CI0.476～0.906)were the predictors of MI-CAD.The area under the ROC curve of the combined factors for predicting MINOCA was 0.810.4.The following indicators were statistically different between the subgroups of MINOCA patients with and without in-hospital MACE events(p<0.05): in length of stay,family history of cardiovascular disease,differences in abnormal ventricular wall systole indicated by cardiac ultrasound,pericardial effusion,ALT measurements,use ofβ-R blockers,CCB,diuretics,and digaoxin.Binary regression analysis showed that pericardial effusion was an independent predictor of in-hospital MACE in MINOCA patients(P<0.01,95%CI 8.159～1677.803),and the area under the ROC curve was 0.794 for predicting adverse in-hospital outcomes in MINOCA patients.5.In terms of in-hospital MACE events and non-in-hospital MACE events in MI-CAD patients: There were significant differences in the following aspects between different groups(p<0.05).The baseline data included age,length of hospital stay,history of alcohol consumption,history of diabetes,history of valvular heart disease,and history of atrial fibrillation;New-onset atrial fibrillation;Killip level;Echocardiography showed left atrial diameter and pericardial effusion;Biochemical indexes of ALT,AST,FBG,BUN,Scr and hs-c Tn T,NT-pro BNP peak and discharge with presence of aspirin,diuretics,digoxin.Binary regression analysis showed that Killi P classification was an independent predictor of in-hospital MACE events in patients with MI-CAD(P<0.001,95%CI 1.927-4.037),and the area under the ROC curve was 0.813.Conclusions1.MI patients with advanced age,abnormal ventricular wall contraction,higher FBG and hs-c Tn T are more likely to develop MI-CAD.Patients with a history of atrial fibrillation,electrocardiogram indicating premature ventricular contraction,and female MI are more likely to develop MINOCA.2.In MINOCA patients,pericardial effusion is an independent risk factor for in-hospital MACE events.3.Higher Killip grade is an independent risk factor for in-hospital MACE in patients with MI-CAD.4.The in-hospital prognosis of MINOCA patients was poor,and there was no statistically significant difference between MINOCA patients and MI-CAD patients. |
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