Clinical Characteristics,treatments And Prognosis In Patients With ST-segment Elevation And Non-ST-segment Elevation Myocardial Infarction With Non-obstructive Coronary Arteries

Objective:To compare the clinical characteristics,drug treatments at discharge,and 1-year prognosis of patients with ST-segment elevation(STE)and non-ST-segment elevation(NSTE)in myocardial infarction with non-obstructive coronary arteries(MINOCA)population.And to investigate the predictors of adverse prognosis in patients with MINOCA.Methods:A total of 129 patients admitted to the Department of Cardiology of the First Affiliated Hospital of Hebei North University from September 2015 to August 2021 and diagnosed with acute myocardial infarction with coronary angiography showing normal coronary arteries or stenosis of coronary arteries less than 50%were consecutively enrolled.Patients were divided into STE-MINOCA group(n=41)and NSTE-MINOCA group(n=88)according to ST segment elevation of echocardiography.Clinical profiles,laboratory and imaging examination results during hospitalization and drug treatments at discharge were collected,and all patients were followed up for 1 year.The occurrence of major adverse cardiovascular events(MACE)was recorded.Results:1.Comparison of clinical profiles between the STE-MINOCA group and the NSTE-MINOCA group:among the 129 patients with MINOCA in this study,41 cases(31.8%)developed STE-MINOCA and 88 cases(68.2%)developed NSTE-MINOCA.The incidence of NSTE-MINOCA was higher than that of STE-MINOCA.Compared with STE-MINOCA patients,NSTE-MINOCA patients have a higher age of onset(57.72±10.96 vs52.66±11.37,P=0.017)and a higher proportion of females(54.5%vs 34.1%,P=0.031).Diastolic blood pressure was lower(75.14±11.61 vs 81.78±12.69,P=0.004)and heart rate was slower(80.34±15.81 vs 87.07±16.44,P=0.028).In terms of previous medical history,the proportion of patients with a history of smoking was lower in the NSTE-MINOCA group(31.8%vs56.1%,P=0.009).2.Comparison of laboratory and imaging examination results between the STE-MINOCA group and the NSTE-MINOCA group:compared with the NSTE-MINOCA group,the total cholesterol(1.46±0.63 vs 1.80±0.59,P=0.004),low density lipoprotein cholesterol(1.11±0.30 vs 1.24±0.30,P=0.025)and NT-pro BNP(z=-1.965,P=0.049)of the STE-MINOCA group patients were lower during the hospitalization.There were no significant differences in aspartate aminotransferase,creatine kinase isoenzyme and other laboratory indexes between the two groups.There were no significant differences in ejection fraction and imaging examination of abnormal ventricular wall movement between the two groups.3.Drug treatments at discharge between STE-MINOCA group and NSTE-MINOCA group:there was no statistical significance in drug treatments between the two groups.4.Prognosis:A total of 112 patients were followed up,and 17patients(13.18%)were lost to follow-up.Follow-up data were collected from 36 patients in the STE-MINOCA group and 76 patients in the NSTE-MINOCA group.During 1-year follow-up,a total of 31(27.68%)of the 112 patients developed MACE.Among them,7 patients(19.44%)in STE-MINOCA group developed MACE,including 2 patients with recurrent myocardial infarction and 5 patients with recurrent angina.In the NSTE-MINOCA group,24 patients developed MACE(31.58%),including2 patients with heart failure,2 patients with stroke,and 20 patients with recurrent angina.There was no significant difference in the occurrence of MACE between the two groups during 1-year follow-up.5.Comparison of clinical profiles between MINOCA event group and MINOCA non-event group:compared with the non-event group,patients in the event group have a faster heart rate(88.81±17.40 vs 81.31±15.10,P=0.026)and a higher rate of history of hyperlipidemia(45.2%vs 19.8%,P=0.007).6.Comparison of laboratory and imaging examination results during hospitalization between patients in the MINOCA event group and the MINOCA non-event group:there was no statistical significance in laboratory and imaging examination results between the two groups during hospitalization.7.Drug treatments of patients in MINOCA event group and MINOCA non-event group at discharge:compared to the event group,The use rate of ACEI/ARB in the non-event group at discharge was higher(60.5%vs38.7%,χ~2=4.290,P=0.038),and there was no significant difference in the use of P2Y12 receptor antagonists,statins and other secondary preventive drugs between the two groups.8.Multivariate logistic regression analysis of influencing factors of poor prognosis in MINOCA patients:increased heart rate(OR=1.034,95%CI 1.004-1.066,P=0.027)and the history of hyperlipidemia(OR=3.732,95%CI 1.433-9.719,P=0.007)were independent risk factors for MACE.The use of ACEI/ARB at discharge(OR=0.337,95%CI 0.133-0.853,P=0.022)was an independent protective factor for MACE.Conclusions:1.Patients in the STE-MINOCA and NSTE-MINOCA groups had different clinical characteristics.2.The drug use of patients in the STE-MINOCA and NSTE-MINOCA groups was similar at discharge.3.During 1-year follow-up,there was no significant difference in the occurrence of MACE between the STE-MINOCA and the NSTE-MINOCA groups.4.Increased heart rate and the history of hyperlipidemia were independent risk factors for adverse prognosis in MINOCA patients,and the use of ACEI/ARB at discharge was independent protective factor for adverse prognosis.