Clinical Characteristics and Prognosis of MINOCA Caused by Atherosclerotic and Nonatherosclerotic Mechanisms Assessed by OCT

作者：Zeng, Ming; Zhao, Chen; Bao, Xiaoyi; Liu, Minghao; He, Luping; Xu, Yishuo; Meng, Wei; Qin, Yuhan; Weng, Ziqian; Yi, Boling; Zhang, Dirui; Wang, Shengfang; Luo, Xing; Lv, Ying; Chen, Xi; Sun, Qianhui; Feng, Xue; Gao, Zhanqun; Sun, Yanli; Demuyakor, Abigail; Li, Ji; Hu, Sining; Guagliumi, Giulio; Mintz, Gary S.; Jia, Haibo; Yu, Bo

来源：JACC-Cardiovascular Imaging, 2023, 16(4): 521-532.

DOI：10.1016/j.jcmg.2022.10.023

• atherosclerosis
• clinical outcome
• myocardial infarction
• nonsignificant stenosis
• optical coherence tomography

BACKGROUND Myocardial infarction with nonobstructive coronary artery (MINOCA) is a heterogeneous syndrome caused by different pathophysiologic mechanisms. There is limited evidence regarding prognosis of patients with MINOCA caused by different mechanisms.OBJECTIVES The present study aimed to assess the underlying mechanisms of MINOCA by optical coherence to-mography (OCT) and to correlate with clinical outcomes.METHODS Patients with MINOCA were divided into 2 groups based on OCT findings: atherosclerotic MINOCA (Ath-MINOCA) and nonatherosclerotic MINOCA (non-Ath-MINOCA). Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal MI, target lesion revascularization, stroke, and rehospitalization for unstable or progressive angina.RESULTS Among 7,423 patients with a clinical diagnosis of MI who underwent angiography, 190 of 294 MINOCA were studied using OCT. The causes of Ath-MINOCA (n = 99, 52.1%) were plaque erosion (n = 64, 33.7%), plaque rupture (n = 33,17.4%), and calcified nodule (n = 2, 1.1%) whereas the causes of non-Ath-MINOCA (n = 91, 47.9%) were spon-taneous coronary artery dissection (n = 8, 4.2%), coronary spasm (n = 9, 4.7%), and unclassified cause (n = 74, 38.9%). The 1-year MACE was 15.3% for Ath-MINOCA vs 4.5% for non-Ath-MINOCA (P = 0.015). An atherosclerotic cause was an independent predictor of MACE (HR: 5.36 [95% CI: 1.08-26.55]; P = 0.040), mainly driven by target lesion revasculari-zation and rehospitalization, despite the composite endpoint including cardiac death and MI showing no difference.CONCLUSIONS OCT identified a cause in 61.1% of MINOCA, in which Ath-MINOCA represents an important and distinct MINOCA subset. Ath-MINOCA were more common and associated with worse outcomes. (Incidence Rate of Heart Failure After Acute Myocardial Infarction Wit

• 单位
  哈尔滨医科大学