Myocardial infarction with nonobstructive coronary arteries: a single-center retrospective study by sex and race.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Coronary artery disease Pub Date : 2024-12-01 Epub Date: 2024-07-08 DOI:10.1097/MCA.0000000000001402

Christine Hsueh, Ghenekaro Esin, Thomas Breen, Mauro Gitto, Miriam Katz, Martha Gulati, Quinn Capers Iv, Harmony R Reynolds, Annabelle S Volgman, Nanette Wenger, S Elissa Altin

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Abstract

Background: In myocardial infarction with nonobstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race.

Objective: The aim of this study was to assess baseline demographics and 3-year outcomes by sex and race for MINOCA patients.

Methods: Patients admitted to a single center with acute myocardial infarction (MI) between 1 January 2012 and 31 December 2018, were identified by chart and angiographic review. The primary outcome was nonfatal MI with secondary outcomes including nonfatal cerebrovascular accident (CVA), chest pain readmission, and repeat coronary angiography.

Results: During the study period, 304 patients were admitted with MINOCA. The cohort was predominantly female (66.4%), and women were significantly older (64.6 vs. 59.2). One-sixth of the total population were Black patients, and nearly half of Black patients (47.2%) were male. Prior CVA (19.7%) and comorbid anxiety, depression, or post-traumatic stress disorder (41.1%) were common. Rates of nonfatal MI were 6.3% without difference by sex or race. For secondary outcomes, rates of CVA were 1.7%, chest pain readmission was 22.4%, and repeat angiography was 8.9%. Men were significantly more likely to have repeat angiography (13.7 vs. 6.4%), and Black patients were more likely to be readmitted for angina (34.0 vs. 19.1%). Over one-quarter of patients underwent repeat stress testing, with 8.9% ultimately undergoing repeat angiograms and low numbers (0.7%) undergoing revascularization. Men were more likely to be referred for a repeat angiogram (13.7 vs. 6.4%, P = 0.035). In multivariate analysis, Black race [odds ratio (OR), 2.31; 95% confidence interval (CI), 1.06-5.03] was associated with an increased risk of readmission for angina, while female sex was associated with decreased odds of repeat angiography (OR, 0.36; 95% CI, 0.14-0.90) and current smoking was associated with increased odds of repeat angiography (OR, 4.07; 95% CI, 1.02-16.29)] along with hyperlipidemia (OR, 4.65; 95% CI, 1.22-17.7).

Conclusion: White women presented more frequently with MINOCA than White men, however, Black men are equally as affected as Black women. Rates of nonfatal MI were low without statistical differences by sex or race.

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非阻塞性冠状动脉心肌梗死：一项按性别和种族分列的单中心回顾性研究。

背景：在冠状动脉非阻塞性心肌梗死（MINOCA）患者中，按性别和种族划分的患者层面的预后数据非常有限：本研究旨在评估非阻塞性冠状动脉心肌梗死患者的基线人口统计学特征以及按性别和种族划分的 3 年预后：2012年1月1日至2018年12月31日期间，单一中心收治的急性心肌梗死（MI）患者均通过病历和血管造影检查确定。主要结果是非致死性心肌梗死，次要结果包括非致死性脑血管意外（CVA）、胸痛再入院和重复冠状动脉造影：研究期间，304 名患者因 MINOCA 入院。研究对象以女性为主（66.4%），女性年龄明显偏大（64.6 岁对 59.2 岁）。黑人患者占总人数的六分之一，近一半的黑人患者（47.2%）为男性。曾患 CVA（19.7%）和合并焦虑症、抑郁症或创伤后应激障碍（41.1%）的患者很常见。非致命性心肌梗死率为 6.3%，没有性别或种族差异。在次要结果中，CVA 发生率为 1.7%，胸痛再入院率为 22.4%，重复血管造影率为 8.9%。男性接受重复血管造影术的几率明显更高（13.7% 对 6.4%），黑人患者因心绞痛再次入院的几率更高（34.0% 对 19.1%）。超过四分之一的患者接受了重复压力测试，8.9%的患者最终接受了重复血管造影术，接受血管重建术的患者人数较少（0.7%）。男性更有可能接受重复血管造影（13.7% 对 6.4%，P = 0.035）。在多变量分析中，黑人种族[几率比（OR），2.31；95% 置信区间（CI），1.06-5.03]与心绞痛再入院风险增加有关，而女性性别与重复血管造影几率降低有关（OR，0.36；95% CI，0.14-0.90），目前吸烟与重复血管造影的几率增加（OR，4.07；95% CI，1.02-16.29）]以及高脂血症（OR，4.65；95% CI，1.22-17.7）有关：结论：与白人男性相比，白人女性更容易患上 MINOCA，但黑人男性与黑人女性的患病率相当。非致命性心肌梗死的发生率较低，但在性别或种族上没有统计学差异。

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来源期刊

Coronary artery disease 医学-外周血管病

CiteScore

2.50

自引率

0.00%

发文量

190

审稿时长

6-12 weeks

期刊介绍： Coronary Artery Disease welcomes reports of original research with a clinical emphasis, including observational studies, clinical trials, translational research, novel imaging, pharmacology and interventional approaches as well as advances in laboratory research that contribute to the understanding of coronary artery disease. Each issue of Coronary Artery Disease is divided into four areas of focus: Original Research articles, Review in Depth articles by leading experts in the field, Editorials and Images in Coronary Artery Disease. The Editorials will comment on selected original research published in each issue of Coronary Artery Disease, as well as highlight controversies in coronary artery disease understanding and management. Submitted artcles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.