Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study.
Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study.
复制标题
DOI：
10.1161/jaha.118.009174
复制
发表时间：
2018-06-28
影响因子：
5.4
通讯作者：
D'Onofrio G
中科院分区：
文献类型：
--
作者：
Safdar B;Spatz ES;Dreyer RP;Beltrame JF;Lichtman JH;Spertus JA;Reynolds HR;Geda M;Bueno H;Dziura JD;Krumholz HM;D'Onofrio G
我们比较了非阻塞性冠状动脉心肌梗死（MINOCA）与阻塞性疾病（冠状动脉疾病引起的心肌梗死[MI‐CAD]）年轻患者的临床特征和结局，以及MINOCA患者的性别和亚型。2008年至2012年，VIRGO（恢复的变化：性别对年轻AMI患者结局的作用）前瞻性招募了103家医院的18至55岁的急性心肌梗死患者，男女比例为2：1。使用血管造影驱动的分类法，如果存在血运重建或斑块≥50%，则将患者定义为MI‐CAD，如果存在<50%的阻塞或非斑块机制，则将患者定义为MINOCA。排除了未进行血管造影或在血管造影前接受溶栓治疗的患者。结局包括1个月和12个月死亡率和功能（西雅图心绞痛问卷[SAQ]）和心理社会状态。在接受血管造影术的2690例患者中，2374例（88.4%）患有MI‐CAD，299例（11.1%）患有MINOCA，17例（0.6%）仍未分类。女性患MINOCA的几率比男性高5倍（14.9%比3.5%;比值比：4.84; 95%置信区间，3.29-7.13）。MINOCA患者更可能没有传统的心脏风险因素（8.7% vs 1.3%; P<0.001），但比MI‐CAD患者更易发生高凝状态（3.0% vs 1.3%; P=0.036）。与MINOCA组相比，MI‐CAD组女性更可能绝经（55.2% vs 41.2%; P<0.001）或有妊娠糖尿病史（16.8% vs 11.0%; P=0.028）。MINOCA机制各不相同：75例患者（25.1%）确定为非斑块机制，其临床特征和治疗也各不相同。MINOCA和MI‐CAD的1个月和12个月死亡率相似（1个月：分别为1.1%和1.7% [P=0.43]; 12个月：分别为0.6%和2.3% [P=0.68]），校正的12个月SAQ生活质量也相似（分别为76.5和73.5; P=0.06）。MINOCA年轻患者更可能是女性，具有异质性机制特征，临床结局与MI‐CAD患者相当。 URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00597922。
We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI‐CAD]) and among patients with MINOCA by sex and subtype. Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI‐CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1‐ and 12‐month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI‐CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29–7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI‐CAD patients (3.0% versus 1.3%; P=0.036). Women with MI‐CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One‐ and 12‐month mortality with MINOCA and MI‐CAD was similar (1‐month: 1.1% and 1.7% [P=0.43]; 12‐month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12‐month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06). Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI‐CAD patients. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.