| Background: Myocardial infarction with non-obstructive coronary arteries is a group of diseases characterized by definite diagnosis of myocardial infarction and failure to find ≥50% coronary stenosis during angiography.The traditional related risk factors of patients with obstructive myocardial infarction could not well predict the prognosis of patients with coronary artery non-obstructive myocardial infarction.At present,a large number of studies have confirmed the relationship between blood lipid indexes such as LDL-C,non-HDL-C,Apo B and the occurrence and development of coronary heart disease.However,patients with coronary artery non-obstructive myocardial infarction do not have serious plaque load,and there is still a lack of reports on the clinical significance of such blood lipid indexes in patients with coronary artery non-obstructive myocardial infarction.Objective: The clinical characteristics of patients with myocardial infarction with non-obstructive coronary arteries were studied by collecting relevant clinical data of patients who were clearly diagnosed as acute myocardial infarction and confirmed by coronary angiography without obvious obstructed epicardial vessels,and followed up the occurrence of major adverse cardiovascular events(MACE)in patients with telephone follow-up,long-term prognosis and risk factors associated with prognosis.Methods: This study is a single-center,observational cohort study.The enrolled patients were 115 patients who were clearly diagnosed with myocardial infarction with non-obstructive coronary arteries in the Second Hospital of Jilin University from January 2018 to January 2022,and randomly matched patients admitted to the hospital during the same period.Among 115 patients with non-obstructive coronary heart disease,the demographic data,anamnesis,and examination results during hospitalization were analyzed and compared between the two groups.Patients with myocardial infarction with non-obstructive coronary arteries were followed up for a median of 36 months.The study endpoint was major cardiovascular adverse events,including chest pain readmission,recurrent myocardial infarction,heart failure,stroke(including cerebral hemorrhage and cerebral infarction),allcause death(including cardiac death and non-cardiac death),revascularization and heart valve replacement composite endpoint,analysis and comparison of event group and nonevent group patient demographic data,anamnesis,In-hospital inspection results,etc.The demographic data,anamnesis,in-hospital examination results and the occurrence of major cardiovascular adverse events in patients with myocardial infarction with non-obstructive coronary arteries in different gender groups were analyzed and compared.The prognostic risk factors of patients with myocardial infarction with non-obstructive coronary arteries were obtained by survival analysis and regression analysis.Results:(1)The incidence rate of myocardial infarction with non-obstructive coronary arteries in patients who were clearly diagnosed with acute myocardial infarction and underwent coronary angiography was 1.99%(115 cases),the average age was 55.98±12.03 years,and women accounted for 29.57%(34 cases),risk factors followed by smoking history(54.78%),history of hypertension(45.22%),dyslipidemia(33.91%),history of diabetes(9.6%).Compared with patients with coronary atherosclerosis,MINOCA patients accounted for a higher proportion of males,more history of smoking and drinking,and the difference was statistically significant(p<0.05);serum troponin peak value,myoglobin peak value,N-terminal BNP precursor,urea nitrogen,uric acid,serum creatinine,cystatin C,alanine aminotransferase,aspartate aminotransferase,direct bilirubin,free fatty acid,and homocysteine were higher,and the differences were statistically significant(p<0.05);glomerular filtration rate,serum total protein,albumin level,left ventricular ejection fraction were lower,the difference was statistically significant(p<0.05).(2)A total of 28 MACE events occurred in 26 patients(24.30%)during the follow-up period.Using multivariate binary Logistic regression analysis,LDL-C(OR3.492,95% CI: 1.381-8.828,p=0.008),non-HDL-C(OR3.057,95% CI: 1.353-6.904,p =0.007),Apo B(OR1.033,95%CI:1.006-1.060,p=0.016)were independent risk factors for MACE events in patients with myocardial infarction with non-obstructive coronary arteries.ROC curve was drawn according to LDL-C,non-HDL-C and Apo B in MACE event group and nonevent group,and the results showed that the AUC of non-HDL-C on MACE event prediction was 0.736(95%CI: 0.628-0.844,p<0.001),the sensitivity and specificity were 61.5% and 74.1%;the AUC of LDL-C for the prediction of MACE events was 0.746(95%CI: 0.634-0.858,p<0.001),the sensitivity and specificity were 84.6% and 56.8%;the AUC of Apo B for the prediction of MACE events was 0.728(95%CI: 0.612-0.844,p<0.001),and the sensitivity and specificity were 69.2% and 74.1%,respectively.(3)Compared with male patients,female patients had a higher incidence of MACE events,a higher age of onset,less history of smoking and drinking,and more history of hypertension(p<0.05).There was no statistical difference in diabetes,dyslipidemia,BMI,ECG ST-T changes(p>0.05);NT-pro BNP,total cholesterol,low-density lipoprotein cholesterol,non-high-density lipoprotein cholesterol,apolipoprotein B in female patients The proportion of patients with elevated NT-pro BNP was higher,and the difference was statistically significant(p<0.05).Uric acid,serum creatinine,glomerular filtration rate,alanine aminotransferase,albumin,direct bilirubin,and homocysteine were lower,and the difference was statistically significant(p<0.05).Conclusions: 1.Compared with non-obstructive coronary artery disease patients without myocardial infarction,MINOCA patients had higher levels of homocysteine and free fatty acids;2.LDL-C,non-HDL-C,and Apo B are independent risk factors for MACE events in MINOCA patients,and can be used to predict MACE events in MINOCA patients. |
