Clinical Characteristics and Long-Term Outcomes of MINOCA Accompanied by Active Cancer: A Retrospective Insight Into a Cardio-Oncology Center Registry

Abstract

BackgroundClinical characteristics and long-term outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and cancer are insufficiently elucidated.ObjectivesWe sought to characterize these patients hospitalized in a tertiary cardio-oncology center and to find the potential determinants affecting their long-term mortality.MethodsMINOCA was diagnosed in 72 of the 1,011 patients with consecutive myocardial infarction who underwent coronary angiography. Mortality rates and their determinants were analyzed within a median follow-up of 69.2 (37.8–79.9) months.ResultsActive cancer was identified in 21 (29.2%) of patients with MINOCA and in 113 (12.0%) patients with myocardial infarction and obstructive coronary artery disease (MI-CAD) (p < 0.001). MINOCA patients with cancer were characterized by a higher incidence of anemia (47.6 vs. 21.6%, p = 0.03) and more frequently Takotsubo syndrome (19.1 vs. 2.0%, p = 0.01) than in non-cancer MINOCA. The troponin T/hemoglobin ratio was higher in both cancer MINOCA and MI-CAD groups when compared with their respective non-cancer patients (both p < 0.05). The age and sex-standardized mortality rates were significantly higher in cancer MINOCA (26.7%/year) when compared with non-cancer MINOCA (2.3%/year, p = 0.002) and in cancer MI-CAD (25.0%/year) vs. non-cancer MI-CAD (3.7%/year, p < 0.001). Active cancer (HR 3.12, 95% CI 2.41–4.04) was independently associated with higher long-term mortality, while higher hemoglobin levels (HR 0.93, 95% CI 0.88–0.99, per g/dl) and a MINOCA diagnosis (HR 0.69, 95% CI 0.47–0.97) improved long-term survival.ConclusionPatients with MINOCA were comorbid with cancer more frequently than MI-CAD. In turn, an active malignancy was associated with an unfavorable long-term survival both in MI-CAD population and in patients with MINOCA.

Coronary Slow-Flow Phenomenon in Takotsubo Syndrome: The Prevalence, Clinical Determinants, and Long-Term Prognostic Impact

“…Anemia was recognized if the hemoglobin level was <13 g/dL for men and <12 g/dL for women. The cut-off value for the thrombocytopenia was 100 × 10 3 /µL [35,36]. Cardiac necrotic biomarkers including isoenzyme MB of creatine kinase (IU/L, upper limit of normal of 24 IU/L) and the high-sensitive cardiac troponin T (ng/mL, upper limit of normal: 0.014 ng/mL) were measured on admission and at least once within the first 24 h. The peak values during the hospitalization were also analyzed.…”

“…All coronary angiograms were analyzed offline, using two contralateral projections for each artery at baseline by a cardiologist unaware of the clinical data. According to the guidelines, lesions narrowing the coronary artery by <50% were defined as nonobstructive [36]. All patients with non-obstructive stenosis were divided into two groups with either (i) normal coronary arteries or minimal intracoronary irregularities with stenosis of <30% or (ii) mild to moderate lesions of at least 30 and <50% [36].…”

“…According to the guidelines, lesions narrowing the coronary artery by <50% were defined as nonobstructive [36]. All patients with non-obstructive stenosis were divided into two groups with either (i) normal coronary arteries or minimal intracoronary irregularities with stenosis of <30% or (ii) mild to moderate lesions of at least 30 and <50% [36]. Epicardial coronary flow was assessed qualitatively using TIMI flow criteria [27] and quantitatively with TFC [29].…”

Acute coronary syndromes in patients with cancer: Recent advances

“…MINOCA [29] is defined as the triad of acute MI (positive cardiac biomarker and corroborative clinical evidence of infarction), non-obstructive coronaries on angiography (i.e., no coronary stenosis 50%), and the absence of clear specific cause for the acute presentation. A study by Stepien et al [30] demonstrated that patients with MINOCA were found to have higher rates of concurrent cancer, compared to patients with MI and obstructive CAD (MI-CAD). Cancer was also noted to correlate with less a favorable survival rate in both groups of patients.…”

Coronary Artery Ectasia Database — Poland (CARED-POL). The rationale and design of the multicenter nationwide registry

“…Major adverse cardiovascular events (MACE) occur in up to 10% of CAAE patients per year [2]. MI can be caused by in-aneurysm thrombosis with artery closure or distal embolization [3][4][5]. As has been shown, CAAE diagnosis is associated both with increased MI incidence and risk of MI recurrence [6].…”