Clinical Outcomes and Predictors of ST-Elevation Versus Non-ST-Elevation Myocardial Infarction with Non-Obstructive Coronary Arteries

• Published in: The American journal of the medical sciences 2020-12, Vol.360 (6), p.686-692
• Main Authors: Xu, Bin, Abdu, Fuad A., Liu, Lu, Mohammed, Abdul-Quddus, Yin, Guoqing, Luo, Yanru, Xu, Siling, Lv, Xian, Fan, Rui, Che, Wenliang
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; China; Coronary Circulation; Coronary Vessels - pathology; Female; Humans; Male; Middle Aged; MINOCA; Non-ST Elevated Myocardial Infarction - complications; Non-ST Elevated Myocardial Infarction - diagnosis; Non-ST Elevated Myocardial Infarction - pathology; Non-ST Elevated Myocardial Infarction - physiopathology; Non-ST-segment elevation; Outcomes; Predictors; Prognosis; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - pathology; ST Elevation Myocardial Infarction - physiopathology; ST-segment elevation; Young Adult
• ISSN: 0002-9629; 1538-2990
• DOI: 10.1016/j.amjms.2020.07.016

Myocardial infarction with nonobstructive coronary arteries (MINOCA) can be clinically categorized as ST-segment elevation (STE) and non-ST-segment elevation (NSTE), whose clinical prognosis are poorly understood. The aim of this study was to compare the clinical outcome and their predictors of patients with STE and NSTE in MINOCA population. A total of 265 patients with MINOCA (102 with STE, and 163 with NSTE) were consecutively collected. Clinical profile, prognosis, and predictors of all patients were assessed. The proportion of patients with NSTE was greater than patients with STE in MINOCA population. Patients with NSTE were older and more likely to be female and had a higher incidence of atrial fibrillation. Both high density lipoprotein (HDL) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were higher in the NSTE group. Patients with STE were more likely to have a history of smoking and a higher diastolic blood pressure. During the 1-year follow up, there were no differences in the outcomes between the STE and NSTE groups, with no significant differences in mortality and a similar rate of major adverse cardiovascular events (MACE) (20.9% vs 19.3%, P = 0.767). The multivariable predictors of MACE in the NSTE groups were age, lower level of total cholesterol, hypertension, and smoking history, whereas reduced left ventricular ejection fraction, and diabetes mellitus were the multivariable predictors of major adverse cardiac events in the STE group. There were differences in the clinical profile between STE and NSTE in the MINOCA population, whereas the outcomes during the 1-year follow up were similar. The STE and NSTE groups had different predictive factors for major adverse cardiac events.