Abstract 4141570: In-hospital cumulative exposure of inflammation reflect the prognosis of patients with myocardial infarction with nonobstructive coronary artery disease

Background: Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. Inflammation is closely related to the prognosis of such diseases. This study focuses on the correlation between cumulative exposure of inflammation during the hospital stay period and the prognosis of MINOCA patients. Methods: This study was a single-center, prospective cohort study. Patients who underwent coronary angiography and diagnosed with MINOCA in Fuwai Hospital from January 2015 to December 2019 and met the inclusion criteria were enrolled. We mainly explored the correlation between the in-hospital cumulative exposure of inflammation (calculated as the area under the highly sensitive CRP(mg/L)-time(days) curve) and long-time outcomes of MINOCA.Patients had their blood hsCRP levels tested at least twice during their hospital stay. Kaplan-Meier analyses and Cox regression analyses were performed to evaluated survival rate of patients and hazard ratio during a 77.2-month follow-up. ROC analyses were also adapted in this study to detect the best cut-off value for Results: A total of 890 MINOCA patients were enrolled, including 148 (16.6%) with major adverse cardiovascular events (MACEs). Patients in higher quartile group of cumulative exposure to inflammation had an apparently higher rate of MACE during the follow-up time. After adjusted for multiple clinically relevant variables, higher cumulative exposure of inflammation was still associated with an increased risk of MACE (HR=1.79; 95% CI: 1.08-2.92 P<0.001). Moreover, AUC of hsCRP(mg/L)-time(days) had an AUC of 0.72 for MACE prediction with the best cut-off value of 6.36mg*L -1 *d, higher than that of peak hsCRP (AUC 0.64). Conclusions: Inflammation is closely related to the development of disease and adverse events in patients with MINOCA. Cumulative exposure of inflammation during the hospital stay period have better predictive value than single peak-hsCRP index. Routine assessment of hsCRP and AUC of hsCRP-time data may help this specific population benefit from the prognostic information or even guiding the timely initiation of anti-inflammatory treatment.