Background:Suspected myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) occurs in ≈5% to 10% of patients with MI referred for coronary angiography. The prognosis of these patients may differ to those with MI and obstructive coronary artery disease (MI-CAD) and those without a MI (patients without known history of MI [No-MI]). The primary objective of this study is to evaluate the 12-month all-cause mortality of patients with MINOCA.Methods:Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the terms “MI,” “nonobstructive,” “angiography,” and “prognosis” were searched in PubMed and Embase databases from inception to December 2018, including original, English language MINOCA studies with >100 consecutive patients. Publications with a heterogeneous cohort, unreported coronary stenosis, or exclusively focusing on MINOCA-mimicking conditions, were excluded. Unpublished data were obtained from the MINOCA Global Collaboration. Data were pooled and analyzed using Paule-Mandel, Hartung, Knapp, Sidik & Jonkman, or restricted maximum-likelihood random-effects meta-analysis methodology. Heterogeneity was assessed using Cochran’s Q and I² statistics. The primary outcome was 12-month all-cause mortality in patients with MINOCA, with secondary comparisons to MI-CAD and No-MI.Results:The 23 eligible studies yielded 55 369 suspected MINOCA, 485 382 MI-CAD, and 33 074 No-MI. Pooled meta-analysis of 14 MINOCA studies accounting for 30 733 patients revealed an unadjusted 12-month all-cause mortality rate of 3.4% (95% CI, 2.6%–4.2%) and reinfarction (n=27 605; 10 studies) in 2.6% (95% CI, 1.7%–3.5%). MINOCA had a lower 12-month all-cause mortality than those with MI-CAD (3.3% [95% CI, 2.5%–4.1%] versus 5.6% [95% CI, 4.1%–7.0%]; odds ratio, 0.60 [95% CI, 0.52–0.70], P<0.001). In contrast, there was a statistically nonsignificant trend towards increased 12-month all-cause mortality in patients with MINOCA (2.6% [95% CI, 0%–5.9%]) compared with No-MI (0.7% [95% CI, 0.1%–1.3%]; odds ratio, 3.71 [95% CI, 0.58–23.61], P=0.09).Conclusions:In the largest contemporary MINOCA meta-analysis to date, patients with suspected MINOCA had a favorable prognosis compared with MI-CAD, but statistically nonsignificant trend toward worse outcomes compared to those with No-MI.Registration:URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42020145356.

中文翻译：

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疑似心肌梗死伴非阻塞性冠状动脉患者的生存率：来自 MINOCA 全球合作的综合系统评价和荟萃分析

背景：大约 5% 至 10% 的转诊进行冠状动脉造影的 MI 患者发生疑似心肌梗死 (MI) 伴非阻塞性冠状动脉 (MINOCA)。这些患者的预后可能不同于患有 MI 和阻塞性冠状动脉疾病 (MI-CAD) 的患者和没有 MI 的患者（没有已知 MI 病史的患者 [No-MI]）。本研究的主要目的是评估 MINOCA 患者 12 个月的全因死亡率。 ”和“prognosis”在 PubMed 和 Embase 数据库中进行了搜索，从开始到 2018 年 12 月，包括对 >100 名连续患者的原始英语 MINOCA 研究。具有异质性队列的出版物，未报告的冠状动脉狭窄，或专门关注 MINOCA 模拟条件，被排除在外。未发表的数据来自 MINOCA 全球合作组织。使用 Paule-Mandel、Hartung、Knapp、Sidik 和 Jonkman 或受限最大似然随机效应荟萃分析方法汇总和分析数据。使用 Cochran's Q 和 I 评估异质性²统计。主要结果是 MINOCA 患者 12 个月的全因死亡率，与 MI-CAD 和非 MI -MI。对 30 733 名患者的 14 项 MINOCA 研究的汇总荟萃分析显示，未调整的 12 个月全因死亡率为 3.4%（95% CI，2.6%–4.2%）和再梗死（n=27 605；10 项研究） 2.6%（95% CI，1.7%–3.5%）。MINOCA 的 12 个月全因死亡率低于 MI-CAD（3.3% [95% CI, 2.5%–4.1%] vs 5.6% [95% CI, 4.1%–7.0%]；优势比，0.60 [95% CI，0.52–0.70]，P<0.001)。相比之下，与无 MI（0.7% [95% CI， 0.1%–1.3%]；优势比，3.71 [95% CI，0.58–23.61]，P = 0.09。结论：在迄今为止最大的当代 MINOCA 荟萃分析中，与 MI 相比，疑似 MINOCA 的患者预后良好-CAD，但与无 MI.Registration:URL: https://www.crd.york.ac.uk/PROSPERO/ 相比，结果更差的趋势在统计上不显着；唯一标识符：CRD42020145356。