Clinical Outcomes and Predictors of ST-Elevation Versus Non-ST-Elevation Myocardial Infarction with Non-Obstructive
Bin Xu1, Fuad A Abdu2, Lu Liu2
1Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Medical College of Soochow University, Suzhou, China.
Insights
Myocardial infarction with nonobstructive coronary arteries (MINOCA) patients with ST-segment elevation (STE) and non-ST-segment elevation (NSTE) have similar 1-year outcomes, but different predictors for major adverse cardiovascular events.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents challenges in understanding prognosis.
- MINOCA is categorized into ST-segment elevation (STE) and non-ST-segment elevation (NSTE) types.
- Clinical outcomes and predictors for STE-MINOCA and NSTE-MINOCA are not well-defined.
Purpose of the Study:
- To compare the clinical outcomes of patients with STE-MINOCA and NSTE-MINOCA.
- To identify predictors of major adverse cardiovascular events (MACE) in both STE-MINOCA and NSTE-MINOCA populations.
Main Methods:
- A cohort of 265 MINOCA patients (102 STE, 163 NSTE) was analyzed.
- Clinical profiles, prognoses, and predictors of MACE were assessed.
- 1-year follow-up data was collected for all participants.
Main Results:
- NSTE-MINOCA patients were older, more frequently female, and had higher rates of atrial fibrillation and NT-proBNP.
- STE-MINOCA patients had higher rates of smoking history and diastolic blood pressure.
- No significant differences in 1-year mortality or MACE rates were observed between STE-MINOCA and NSTE-MINOCA groups.
Conclusions:
- Despite differing clinical profiles, STE-MINOCA and NSTE-MINOCA patients exhibit similar 1-year cardiovascular outcomes.
- Predictive factors for MACE differ significantly between STE-MINOCA and NSTE-MINOCA groups.
- Age, low total cholesterol, hypertension, and smoking history predict MACE in NSTE-MINOCA.
- Reduced ejection fraction and diabetes mellitus predict MACE in STE-MINOCA.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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