Abstract
BackgroundThe disparity between ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery (STE-MINOCA and NSTE-MINOCA) are unclear. Our study aims to compare the clinical features and outcomes in patients with STE-MINOCA and NSTE-MINOCA.MethodsThis cross-sectional study consecutively enrolled patients diagnosed with acute myocardial infarction (AMI) from January 2013 to January 2020. MINOCA were identified as angiographic stenosis < 50%. Clinical characteristics, angiographic features, and clinical outcomes of STE-MINOCA and NSTE-MINCOA were documented. The primary endpoint was composite events in the different time periods.ResultsA total of 1966 AMI patients were screened, 107 (5.4%) were diagnosed as MINOCA. Among, there were 34 (31.8%) of STE-MINOCA and 73 (68.2%) of NSTE-MINOCA. STE-MINOCA group were younger, had lower N-terminal pro-brain natriuretic peptide (NT-proBNP), and smaller left atrial diameter (P < 0.05). Dual antiplatelet therapy (DAPT) was more likely to be prescribed to STE-MINOCA patients (P = 0.015). During median follow-up time of 24.5 months, STE-MINOCA group also demonstrated lower risks for primary endpoint and cardiovascular-related (CVS) rehospitalization. In univariate Cox regression analyses, NSTE-MINOCA showed an increased risk of long-term primary endpoint (HR 2.57, 95 CI%: 1.10–6.02) and CVS-related rehospitalization (HR 3.14, 95% CI: 1.16–8.48). After adjusting for NT-proBNP and DAPT, NSTE-MINOCA remained an independent risk factor for CVS-related rehospitalization in long-term follow-up (HR 2.78, 95% CI: 1.03–7.49).ConclusionAlthough STE-MINOCA and NSTE-MINOCA patients showed similar clinical characteristics, NSTE-MINOCA group presented a worse long-term outcome mainly driven by CVS-related hospitalization which suggested that NSTE-MINOCA patients might also require prompt medical attention.
Highlights
Myocardial infarction without obstructive coronary artery (MINOCA) is a distinctive entity differing from classic acute myocardial infarction (AMI) [1]
AMI can be classified as ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) according to the presentation of electrocardiogram (ECG) [6]
Worse short-term outcome was observed in STEMI patients, and worse longterm outcome in NSTEMI patients [8, 9]
Summary
Myocardial infarction without obstructive coronary artery (MINOCA) is a distinctive entity differing from classic acute myocardial infarction (AMI) [1]. AMI can be classified as ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) according to the presentation of electrocardiogram (ECG) [6]. For MINOCA, any causes leading to total occlusion of a coronary artery tend to have STEMI, or partial occlusion of arteries tend to have NSTEMI [7]. Consider the distinct pathophysiology in MINOCA, there were lack of evidence regarding the outcomes in patients with STEMINOCA and NSTE-MINOCA. The disparity between ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery (STE-MINOCA and NSTE-MINOCA) are unclear. Our study aims to compare the clinical features and outcomes in patients with STE-MINOCA and NSTE-MINOCA
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