It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37–62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97–5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04–7.04, p = 0.040 respectively). Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.

中文翻译：

---

心血管磁共振对冠状动脉非阻塞性心肌梗死患者预后的影响


据估计，5% 至 10% 的心肌梗塞 (MI) 患者没有出现阻塞性冠状动脉病变。到目前为止，大多数研究都集中在急性冠状动脉综合征上，包括具有相似表现的不同临床实体，涵盖在术语 MINOCA（非阻塞性冠状动脉 MI）下。本研究的目的是评估在没有明显冠状动脉病变的情况下，经心血管磁共振 (CMR) 证实诊断为真正梗塞的患者的预后。前瞻性多中心注册研究，包括 120 名连续患有 CMR 确诊的心肌梗死且无阻塞性冠状动脉病变的患者。主要临床结局是三年内评估的主要不良心血管事件（MACE：死亡、非致命性梗死、中风或心脏再入院）。 76 名患者（63.3%）因急性冠状动脉综合征入院，44 名患者（36.6%）因其他原因（主要是心力衰竭）入院；通过 CMR 确诊。大多数患者（64.2%）是男性，平均年龄为 58.8 ± 13.5 岁。患有小梗塞的患者：83 例 (69.1%) 在一两个心肌节段中显示晚期钆增强 (LGE)，主要是透壁性（77.5% 的患者），并且左心室射血分数保留（中位值 54.8%，四分位距 37） –62）。最常见的梗塞位置是下外侧（n = 38，31.7%）。随访期间，43 名患者 (35.8%) 出现 MACE，其中 9 名 (7.5%) 死亡。在多变量分析中，两个心肌节段与一个心肌节段的 LGE 使不良心脏事件的风险增加一倍（风险比 [HR] 2.32，95% 置信区间 [CI] 0.97–5.83，p = 0.058）。三个或更多心肌节段受累几乎使风险增加三倍（HR 2.71, 95% CI 1.04–7.04, p = 0.040 分别）。患有真正的心肌梗死但没有明显冠状动脉病变的患者主要有小梗塞。心肌 3 段 LGE 受累与不良心脏事件的风险显着升高相关。