Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2018
Thesis Language: Turkish
Student: MURAT OĞUZ ÖZİLHAN
Supervisor: HÜSEYİN MURAT ÖZDEMİRAbstract:
Our study was planned retrospectivly in a single center. Patients who were admitted to Gazi University Faculty of Medicine Emergency Department between August 2013 and April 2018 and who were diagnosed with AMI according to then-valid diagnostic criteria were identified and patients who could not undergo coronary angiography were excluded from the study. The angiograms of all patients in our coronary angiography laboratory were evaluated. The patients who had 50% or more stenosis in any major epicardial coronary artery were included in this evaluation and the patients who did not have MICAD, were included in the MINOCA group. After that, the clinical features, in-hospital and out-of-hospital mortality of both groups were compared. Comparative total mortality analysis was further done after selecting a subgroup of MICAD patients with similar baseline clinical characterstics to those in MINOCA by using case-control compliance method and comparing the total mortality rate in this subgroup versus MINOCA. 857 patients were included in the study. The mean follow-up period was 32.7 ± 16.9 months. When classified according to coronary angiography findings, 98 of them were MINOCA and 759 of them were MICAD. The rate of MINOCA patients in all patients was 11.4% and it was composed of younger patients (49.5 ± 16.7 years, 61.5 ± 12.8 years; p = 0.0001). The female gender ratio in patients 71 with MINOCA was signifcantly higher than that of the MICAD group (37.8% vs 22.7%; p = 0.001). The left ventricular ejection fraction was 54.6 ± 10.1% in MINOCA and 48.5 ± 9.3% in MICAD (p = 0.0001). The incidence of diabetes mellitus, hypertension and hyperlipidemia was significantly lower in the MINOCA group (p = 0.0001; p = 0.0001; p = 0.019). In the MINOCA group, personal and family history of coronary artery disease were lower than the other group (p = 0.0001; p = 0.0001). The AMI type was found to be more frequently of the NSTEMI type in the MINOCA group (MINOCA 63.3%; MICAD 44.8%; p = 0.001). The incidence of MINOCA was 7.9% (36 patients) in STEMI cases and 15.4% (62 patients) in NSTEMI cases (p = 0.001). In-hospital mortality rate was 1 % and out-of-hospital mortality rate was 7.1 % in the MINOCA group. The corresponding rates for the MICAD group were 5.1% and 12.1 %, respectively . The total mortality rate was significantly lower in the MINOCA group (p = 0.01). On the other hand, when a subgroup of MICAD patients, selected by utilising case-control compliance method, were taken into the mortality analysis, the total mortality rates were found to be similar in the 2 groups (p = 0.59). In conclusion, the incidence of MINOCA in our series was 11.4%. MINOCA patients have differences in terms of their demographic characteristics and frequency of cardiovascular risk factors compared to patients with MICAD. Although the survival of the MINOCA group seems to be better at a first glance, it was observed that the mortality of MINOCA was not different from MICAD when patients with similar clinical features were compared.