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

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 99 th percentile, and proinflammatory 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.

Myocardial Blood Flow and Flow Reserve in Patients With Acute Myocardial Infarction and Obstructive and Non-Obstructive Coronary Arteries: CZT SPECT Study

“…The prognosis in MINOCA compared to MICAD remains controversial. Although earlier studies suggested a better prognosis of MINOCA as compared to MI with obstructive coronary artery disease (44,45) more recent studies showed no differences in prognosis among MINOCA and patients with MICAD (46)(47)(48). In this study, two patients with MICAD suffered myocardial infarction during the follow-up period.…”

Serum cytokines levels in patients with myocardial infarction with non-obstructive and obstructive coronary arteries

“…Кроме того, для пациентов с ИМБОКА наличие хронического воспаления было показано ранее [4,6]. При этом очагами воспаления у пациентов с ИМБОКА могут являться как нестенозирующие атеросклеротические бляшки, так и дисфункциональное микрососудистое русло [4][5][6]. Так, было выявлено повышение концентрации СРБ, снижение резерва коронарного кровотока и взаимосвязь с хроническим воспалением у пациентов со стабильной стенокардией без стенозирующего атеросклероза [29].…”

“…Наличие микрососудистой дисфункции не исключалось у пациентов ИМБОКА с повышенными провоспалительными цитокинами через 3 мес. от индексного события и обсуждалось в позиционном документе по коронарной микрососудистой дисфункции [5,30].…”

Myocardial Infarction With Non-obstructive Coronary Arteries: Risk Factors and Associated Comorbidities

“…Moreover, a recent observational study reported that the number of pro-inflammatory conditions—i.e., autoimmune disorders, connective tissue diseases, active cancer, and infections—was significantly higher in the MINOCA group. Nonetheless, neither all-cause mortality nor hospitalisations for cardiovascular causes differed between the groups at follow-up ( 31 ). At present, the role of inflammatory and autoimmune diseases in the development of SCAD remains controversial.…”

“…- Anxiety and depression : although anxiety and depression are rather frequent both in MINOCA and in MI with obstructive CAD, psychosocial disorders are more typical of MINOCA ( 31 , 32 ). In a Taiwanese nationwide population-based study including more than 10,000 patients with non-obstructive CAD, over 38% had a prior anxiety disorder ( 33 ).…”