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Clinical characteristics and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): A prospective single-center study

Javier Lopez-Pais, Bárbara Izquierdo Coronel, David Galán Gil, Maria Jesús Espinosa Pascual, Blanca Alcón Durán, Carlos Gustavo Martinez Peredo, Carlos Moreno Vinués, Paula Awamleh García, Jose Ramón Gonzalez-Juanatey, Javier Muñiz García, Joaquín Jesús Alonso Martín
DOI: 10.5603/CJ.a2020.0146
·
Pubmed: 33140385

open access

Ahead of print
Original articles
Published online: 2020-10-30

Abstract

Background: A definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) was published by European Society of Cardiology in 2016. The aim of this study is to analyze the clinical profile and prognosis of these patients in a prospective single-center study and compare it with the literature data.

Methods: During a 3-year period, information from every consecutive MINOCA patient was gathered (n = 109). It was then compared with 412 contemporaneous patients with myocardial infarction and obstructive coronary arteries (MIOCA). Univariate and multivariate analyses were performed. Prognosis analysis was adjusted by age and cardiovascular risk factors (CVRF).

Results: MINOCA represented 16.9% of the total of patients admitted for myocardial infarction. Compared with MIOCA, they had more psychosocial disorders (22.9% vs. 10.7%; p < 0.01) and more pro-inflammatory conditions (34.9% vs. 14.0%; p < 0.01). Atrial fibrillation was twice as frequent in MINOCA (14.7% vs. 7.3%; p = 0.016). Predictors of MINOCA were as follows: female gender, absence of diabetes, absence of tobacco use, tachycardia, troponin above 10 times the 99th percentile, and pro-inflammatory conditions. Median follow-up was 17.3 ± 9.3 months. Major adverse cardiovascular events (MACE; a composite of a recurrence of acute myocardial infarction, transient ischemic attack/stroke, or death from cardiovascular cause and death from any cause) occurred in 10.8% of the MINOCA group as compared with 10.7% in the MIOCA group (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.58–2.45; p = 0.645). Cardiovascular re-admission rates were higher in the MINOCA group: 19.8% vs. 13.9% (HR 1.85; CI 1.06–3.21; p = 0.030).

Conclusions: The frequency of MINOCA is high, with fewer CVRF, and it is linked to atrial fibrillation, psychosocial disorders, and pro-inflammatory conditions. Mid-term prognosis is worse than previously thought, with a similar proportion of MACE as compared to MIOCA, and even a higher rate of cardiovascular re-admissions.

Abstract

Background: A definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) was published by European Society of Cardiology in 2016. The aim of this study is to analyze the clinical profile and prognosis of these patients in a prospective single-center study and compare it with the literature data.

Methods: During a 3-year period, information from every consecutive MINOCA patient was gathered (n = 109). It was then compared with 412 contemporaneous patients with myocardial infarction and obstructive coronary arteries (MIOCA). Univariate and multivariate analyses were performed. Prognosis analysis was adjusted by age and cardiovascular risk factors (CVRF).

Results: MINOCA represented 16.9% of the total of patients admitted for myocardial infarction. Compared with MIOCA, they had more psychosocial disorders (22.9% vs. 10.7%; p < 0.01) and more pro-inflammatory conditions (34.9% vs. 14.0%; p < 0.01). Atrial fibrillation was twice as frequent in MINOCA (14.7% vs. 7.3%; p = 0.016). Predictors of MINOCA were as follows: female gender, absence of diabetes, absence of tobacco use, tachycardia, troponin above 10 times the 99th percentile, and pro-inflammatory conditions. Median follow-up was 17.3 ± 9.3 months. Major adverse cardiovascular events (MACE; a composite of a recurrence of acute myocardial infarction, transient ischemic attack/stroke, or death from cardiovascular cause and death from any cause) occurred in 10.8% of the MINOCA group as compared with 10.7% in the MIOCA group (hazard ratio [HR] 1.19, 95% confidence interval [CI] 0.58–2.45; p = 0.645). Cardiovascular re-admission rates were higher in the MINOCA group: 19.8% vs. 13.9% (HR 1.85; CI 1.06–3.21; p = 0.030).

Conclusions: The frequency of MINOCA is high, with fewer CVRF, and it is linked to atrial fibrillation, psychosocial disorders, and pro-inflammatory conditions. Mid-term prognosis is worse than previously thought, with a similar proportion of MACE as compared to MIOCA, and even a higher rate of cardiovascular re-admissions.

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Keywords

myocardial infarction with non-obstructive coronary arteries (MINOCA), prognosis, definition, proinflammatory, atrial fibrillation

About this article
Title

Clinical characteristics and prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): A prospective single-center study

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-10-30

DOI

10.5603/CJ.a2020.0146

Pubmed

33140385

Keywords

myocardial infarction with non-obstructive coronary arteries (MINOCA)
prognosis
definition
proinflammatory
atrial fibrillation

Authors

Javier Lopez-Pais
Bárbara Izquierdo Coronel
David Galán Gil
Maria Jesús Espinosa Pascual
Blanca Alcón Durán
Carlos Gustavo Martinez Peredo
Carlos Moreno Vinués
Paula Awamleh García
Jose Ramón Gonzalez-Juanatey
Javier Muñiz García
Joaquín Jesús Alonso Martín

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