Damiano Fedele, Daniele Cavallo, Francesca Bodega, Nicole Suma, Lisa Canton, Mariachiara Ciarlantini, Khrystyna Ryabenko, Sara Amicone, Virginia Marinelli, Claudio Asta, Giuseppe Pastore, Marcello Casuso Alvarez, Rebecca Belà, Angelo Sansonetti, Francesco Angeli, Matteo Armillotta, Alberto Foà, Luca Bergamaschi, Pasquale Paolisso, Marta Belmonte, Paola Rucci, Emanuele Barbato, Carmine Pizzi
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引用次数: 0
Abstract
Background: Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.
Methods: Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA. Newcastle-Ottawa Scale was used for quality assessment. The pooled prevalence of pathological findings was estimated with random-effects models. Pooled risk ratios (RRs) with 95% CIs of all-cause death, MI and the composite of both in patients with NObs-CA versus NCA were calculated at short-term (<1 month), 1-year and long-term follow-up (> 1 year).
Results: Forty-five studies including 17 539 patients were analysed. The pooled prevalence of NObs-CA at ICA was 53% (95% CI 0.47 to 0.60). OCT showed acute pathological findings in 62% (95% CI 0.44 to 0.78) of patients and coronary vasomotor tests were positive in 49% (95% CI 0.31 to 0.67). NObs-CA compared with NCA was associated with an increased 1-year risk of all-cause death or MI (RR=1.49 (95% CI 1.17 to 1.90)) and MI alone (RR=1.80 (95% CI 1.26 to 2.59)), whereas the risk of all-cause death was comparable. Similar results were seen at long-term, but not at short-term follow-up.
Conclusions: Stratification of MINOCA into NObs-CA versus NCA has prognostic value. OCT and vasospasm testing, often informative about the pathological mechanism of MINOCA, should be part of an invasive diagnostic algorithm.
背景：非阻塞性冠状动脉（MINOCA）心肌梗死的病理机制是不均匀的，对预后的影响是未知的，在临床实践中常常未被认识。本研究旨在评估MINOCA患者有创冠状动脉造影（ICA）、光学相干断层扫描（OCT）和冠状动脉功能检查病理结果的患病率和预后影响。方法：在PubMed和SCOPUS上检索截至2023年8月发表的研究，并纳入报告非阻塞性冠状动脉(NObs-CA；冠状动脉狭窄1-49%)与正常冠状动脉(NCA；（0%冠状动脉狭窄），病理表现为OCT，和/或MINOCA的冠状动脉血管舒张试验。采用纽卡斯尔-渥太华量表进行质量评价。用随机效应模型估计病理结果的总患病率。在短期内（1年）计算NObs-CA与NCA患者的全因死亡、心肌梗死和两者的综合95% ci的合并风险比（rr）。结果：共纳入45项研究，包括17 539例患者。ICA时NObs-CA的总患病率为53% （95% CI 0.47 - 0.60）。62% （95% CI 0.44 ~ 0.78）的患者OCT显示急性病理表现，49% （95% CI 0.31 ~ 0.67）的患者冠脉血管舒张试验呈阳性。与NCA相比，NObs-CA与全因死亡或心肌梗死的1年风险增加相关（RR=1.49 (95% CI 1.17至1.90)）和单独心肌梗死（RR=1.80 (95% CI 1.26至2.59)），而全因死亡的风险是可比的。在长期随访中也看到了类似的结果，但在短期随访中却没有。结论：MINOCA分层为NObs-CA和NCA具有预后价值。OCT和血管痉挛测试通常能提供有关MINOCA病理机制的信息，应作为有创诊断算法的一部分。普洛斯彼罗注册号：CRD42023468183。
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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