부산대학교 도서관

Background: A certain percentage of patients with acute myocardial infarction (AMI) do not have significant stenosis and they are termed as 'myocardial infarction with nonobstructive coronary arteries (MINOCA)”. However, there were few studies representing MINOCA patients in the era of coronary intervention, in Asia in particular.Aims: We aimed to elucidate the clinical characteristics and in-hospital outcomes of patients with MINOCA in Japan by using a real-world database.Methods: The Japan Acute Myocardial Infarction Registry (JAMIR) is a nationwide, real-world multi-center registry study. We retrospectively analyzed 22,236 AMI patients (68±13 years, female 23.4%) enrolled in the JAMIR between 2011 and 2016.Results: Of those, 286 patients (1.3%) were diagnosed as MINOCA following coronary angiography and the remaining 21,950 patients (98.7%) were inevitably as myocardial infarction with obstructive coronary artery disease (MI-CAD). MINOCA patients were characterized by younger age, higher prevalence of women, fewer coronary risk factors, lower rate of ST-elevation AMI, lower Killip classes, and lower peak creatinine phosphokinase levels as compared to those with MI-CAD. In-hospital all-cause mortality was not different between MINOCA and MI-CAD groups (5.2% vs. 5.7%, P=0.82, OR adjusted by age and sex 1.06; 95%CI [0.63-1.80]), meanwhile non-cardiac mortality was significantly higher in the MINOCA group (4.2% vs. 1.6%, P<0.01, adjusted OR 3.14; 95%CI [1.74-5.68]) (Figure A). Importantly, non-cardiac mortality increased with age in the MI-CAD group, whereas this did not apply in the MINOCA group (Figure B).Conclusions: The large-scale real-world database JAMIR demonstrated high prevalence of non-cardiac death in MINOCA, which indicate a clinical significance of comprehensive evaluations concerning underlying pathophysiological mechanisms of myocardial injury, especially in the younger patient group.