{"title":"非阻塞性冠状动脉心肌梗死（MINOCA）的发病率及预后","authors":"I. Chamtouri , W. Jomaa , A. Turki , K. Ben Hamda","doi":"10.1016/j.acvd.2024.10.089","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine.</div></div><div><h3>Objective</h3><div>To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction.</div></div><div><h3>Method</h3><div>A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed.</div></div><div><h3>Results</h3><div>The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47<!--> <!-->±<!--> <!-->14.9 <em>vs.</em> 60.7<!--> <!-->±<!--> <!-->12.4 years), more often males (87.2% <em>vs.</em> 78.7%) with significantly lower rates of diabetes mellitus (19.1% <em>vs.</em> 36.4%, <em>p</em> <!-->=<!--> <!-->0.015), hypertension (10.6% <em>vs.</em> 30.6%, <em>p</em> <!-->=<!--> <!-->0.003), kidney disease (2.1% <em>vs.</em> 7.8%, <em>p</em> <!-->=<!--> <!-->0.032), peripheral artery disease (2.8% <em>vs.</em> 8.3%, <em>p</em> <!-->=<!--> <!-->0.015) and previous MI (2.1% <em>vs.</em> 11.1%, <em>p</em> <!-->=<!--> <!-->0.028) comparing to patients with obstructive coronary artery disease (CAD). History of smoking was more common in the MINOCA group. Typical chest pain at presentation was higher in MINOCA patients (98.6% <em>vs.</em> 93,4%, <em>p</em> <!-->=<!--> <!-->0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% <em>vs.</em> 9.6%, <em>p</em> <!--><<!--> <!-->0.001; 7.6 <em>vs.</em> 13.8%, <em>p</em> <!-->=<!--> <!-->0.036 respectively).</div></div><div><h3>Conclusion</h3><div>MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA.</div></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":"118 1","pages":"Page S22"},"PeriodicalIF":2.2000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Incidence and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)\",\"authors\":\"I. Chamtouri , W. Jomaa , A. Turki , K. Ben Hamda\",\"doi\":\"10.1016/j.acvd.2024.10.089\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine.</div></div><div><h3>Objective</h3><div>To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction.</div></div><div><h3>Method</h3><div>A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed.</div></div><div><h3>Results</h3><div>The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47<!--> <!-->±<!--> <!-->14.9 <em>vs.</em> 60.7<!--> <!-->±<!--> <!-->12.4 years), more often males (87.2% <em>vs.</em> 78.7%) with significantly lower rates of diabetes mellitus (19.1% <em>vs.</em> 36.4%, <em>p</em> <!-->=<!--> <!-->0.015), hypertension (10.6% <em>vs.</em> 30.6%, <em>p</em> <!-->=<!--> <!-->0.003), kidney disease (2.1% <em>vs.</em> 7.8%, <em>p</em> <!-->=<!--> <!-->0.032), peripheral artery disease (2.8% <em>vs.</em> 8.3%, <em>p</em> <!-->=<!--> <!-->0.015) and previous MI (2.1% <em>vs.</em> 11.1%, <em>p</em> <!-->=<!--> <!-->0.028) comparing to patients with obstructive coronary artery disease (CAD). History of smoking was more common in the MINOCA group. Typical chest pain at presentation was higher in MINOCA patients (98.6% <em>vs.</em> 93,4%, <em>p</em> <!-->=<!--> <!-->0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% <em>vs.</em> 9.6%, <em>p</em> <!--><<!--> <!-->0.001; 7.6 <em>vs.</em> 13.8%, <em>p</em> <!-->=<!--> <!-->0.036 respectively).</div></div><div><h3>Conclusion</h3><div>MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA.</div></div>\",\"PeriodicalId\":55472,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases\",\"volume\":\"118 1\",\"pages\":\"Page S22\"},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1875213624004340\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1875213624004340","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/15 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
心肌梗死（MI）合并非阻塞性冠状动脉（MINOCA）是一种异质性实体，在当代医学中经常被忽视。心肌梗死（MI）合并非阻塞性冠状动脉（MINOCA）是一个异质性的实体，在当代医学中经常被忽视。目的评价因心肌梗死入院的患者中MINOCA的发生率和特点。方法回顾性分析法图马布尔吉巴大学心内科B科STEMI登记的连续1734例患者。MINOCA被定义为非阻塞性冠状动脉疾病，既往无冠状动脉血运重建术。评估所有患者的临床情况和预后。结果MINOCA患者占所有心肌梗死患者的比例为2.7%。MINOCA患者较年轻（47±14.9岁比60.7±12.4岁），男性多见（87.2%比78.7%），糖尿病（19.1%比36.4%,p = 0.015）、高血压（10.6%比30.6%,p = 0.003）、肾脏疾病（2.1%比7.8%,p = 0.032）、外周动脉疾病（2.8%比8.3%,p = 0.015）和既往心肌梗死（2.1%比11.1%,p = 0.028）的发生率明显低于阻塞性冠状动脉疾病（CAD）患者。吸烟史在MINOCA组中更为常见。MINOCA患者就诊时的典型胸痛发生率更高（98.6%比93,4%,p = 0.046）。MINOCA患者更常出现前ST段抬高。MINOCA患者的全因住院死亡率和5年随访死亡率较低(1.5% vs. 9.6%, p <；0.001;7.6 vs. 13.8%, p = 0.036)。结论minoca是一组具有挑战性的异质性患者，其临床特征与经典心血管危险因素不同。寻找病因和最终治疗为改善MINOCA患者的预后提供了丰富的途径。
Incidence and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Introduction
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine.
Objective
To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction.
Method
A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed.
Results
The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47 ± 14.9 vs. 60.7 ± 12.4 years), more often males (87.2% vs. 78.7%) with significantly lower rates of diabetes mellitus (19.1% vs. 36.4%, p = 0.015), hypertension (10.6% vs. 30.6%, p = 0.003), kidney disease (2.1% vs. 7.8%, p = 0.032), peripheral artery disease (2.8% vs. 8.3%, p = 0.015) and previous MI (2.1% vs. 11.1%, p = 0.028) comparing to patients with obstructive coronary artery disease (CAD). History of smoking was more common in the MINOCA group. Typical chest pain at presentation was higher in MINOCA patients (98.6% vs. 93,4%, p = 0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% vs. 9.6%, p < 0.001; 7.6 vs. 13.8%, p = 0.036 respectively).
Conclusion
MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA.
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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