Evaluation of systemic inflammatory parameters in MINOCA patients

Objectives: Despite the advances in diagnosis and treatment, myocardial infarction (MI) is still an important cause of morbidity and mortality problems. Although a high rate of epicardial coronary artery stenosis is observed in coronary angiography (CAG) performed in MI cases, no significant stenosis may be detected at a rate of %5-10.This clinical condition is defined as MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries).While there are many diagnostic and treatment guidelines for obstructive coronary artery disease, awareness and treatment recommendations in the patient group that fits the definition of MINOCA, which has entered our literature in recent years, is an issue open to development. The term MINOCA covers different diagnoses such as dilated cardiomyopathy, hypertrophic cardiomyopathy, coronary vasospasm, slow flow, Takotsubo syndrome. Diagnosis of MINOCA is important in determining the etiology and providing targeted treatment. While the role of atherosclerosis and inflammation in obstructive coronary artery disease is clear, inflammation is also thought to play a role in the pathogenesis ofMINOCA. There are many studies on the predictive value of systemic inflammatory markers in obstructive coronary artery disease. However, the clinical predictive value of systemic inflammatory parameters in MINOCA patients continues to be investigated. The aim of our study is to investigate the clinical predictive value of systemic inflammatory parameters in patients diagnosed with obstructive coronary artery disease, diagnosed with MINOCA and undergoing elective CAG who were evaluated at the Cardiology Department of Tokat Gaziosmanpaşa University, Faculty of Medicine. Methods:496 patients who underwent CAG by the Cardiology Department of Tokat Gaziosmanpaşa University Faculty of Medicine Hospital between 01.01.2023 and 01.01.2024 and who were determined according to the inclusion and exclusion criteria were included in our study. The anamnesis and physical examination findings of the patients included in the study were recorded in the hospital system. Patients with renal failure, severe heart valve disease, connective tissue disease, tachyarrhythmia, bradyarrhythmia, pacemaker rhythm, presence or suspicion of acute pulmonary embolism, presence or suspicion of acute cerebrovascular disease were not included in our study. Patients underwent CAG with a transfemoral or transradial approach in our center. Patients with positive cardiac enzymes and less than %50 stenosis in coronary arteries or no stenosis were classified as group 1, patients with positive cardiac enzymes and %50 or more stenosis in one or more coronary arteries were classified as group 2, patients with negative cardiac enzymes and who underwent elective CAG and no significant stenosis in coronary arteries were classified as group 3.Patients complete blood count and biochemistry results were obtained from the hospital data storage system. It was considered statistically significant if the p value was less than 0.05. Results: Myocardial infarction (MI) critical stenosis class male rate and the rate of patients with diabetes and hypertension were stronger than the other two groups and this difference was significant (p<0.001). Neutrophil count, SII and NLR values were highest in the MI critical stenosis group and lowest in the elective CAG noncritical stenosis group. This difference between all three groups is statistically significant (p<0.001). LVEF value is highest in elective CAG noncritical stenosis group and lowest in MI critical stenosis group. This difference between all three groups is statistically significant (p<0.001). PLR and MLR values are higher in MI critical stenosis group than in elective noncritical stenosis group and this increase is statistically significant (p<0.001). In our study, a positive correlation was found between SII and age (r:0.175, p<0.001), neutrophil count (r:0.693, p<0.001), platelet count (r:0.294, p<0.001), WBC level (r:0.441, p<0.001), creatinine level (r:0.173, p<0.001), glucose level (r:0.265, p<0.001), SPAP value (r:0.193, p<0.001), CRP (r:0.197, p<0.001), and ProBNP (r:0.259, p<0.001) levels. A negative correlation was found between SII and lymphocyte count (r: -0.495, p<0.001), hemoglobin level (r: -0.164, p<0.001), albumin level (r: -0.104, p:0.02), LVEF value (r: -0.223, p<0.001). Conclusion:Our study investigates the predictive value of inflammatory parameters in the diagnosis of MINOCA. In our study, SİI, neutrophil count and NLR values were found to be significantly higher in the MINOCA group compared to the elective noncritical stenosis group. Again, these values were found to be higher in the MI critical stenosis group compared to the MINOCA group. LVEF, PLR and MLR values were also found to be significantly different in the MI critical stenosis group compared to the other two groups. According to our study results, SİI, neutrophil count and NLR values are cheap and easily accessible markers that can be used to predict MINOCA patients in ACS. Keywords: MINOCA, Systemic Immune‐ Inflammation Index, Coronary Angiography