Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry

Abstract

Background: Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). Methods: We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. Results: Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). Conclusions: This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up.

Myocardial Infarction with Nonobstructive Coronary Arteries: A Diagnostic Challenge

“…4 Unfortunately, poor physician awareness results in missed diagnosis following a normal coronary angiogram, 8 leading to early discharge from clinic without appropriate investigation and management. 3,8 Such patients may incur significant financial costs through repeated hospital visits. 9 Atrial fibrillation is the commonest embolic cause of MINOCA 7 (accounting for up to 3% of cases 2 ) and an independent risk factor.…”

“… 2 Among patients with MI, it has been found that up to 10 to 15% have normal coronary arteries on angiography. 1 3 4 5 6 This results in a diagnosis of MI with nonobstructive coronary arteries (MINOCA). MINOCA is a working diagnosis 3 4 5 6 7 8 with a predilection for younger non-white women (younger than 55 years) without traditional cardiovascular risk factors.…”

“… 1 3 4 5 6 This results in a diagnosis of MI with nonobstructive coronary arteries (MINOCA). MINOCA is a working diagnosis 3 4 5 6 7 8 with a predilection for younger non-white women (younger than 55 years) without traditional cardiovascular risk factors. 1 2 3 4 7 Diagnosis requires the following 2 4 6 8 :…”

“… 5 MINOCA is heterogenic and warrants further investigation. 1 2 3 5 6 7 Performance of these tests is limited by availability, cost, and expertise, 1 particularly in developing economies.…”

Myocardial Infarction with Nonobstructive Coronary Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

“…3,6 It is unclear if there is a true difference in the prevalence of traditional coronary artery disease (CAD) risk factors in patients with MINOCA as the clinical literature has been divided in this regard. 4,6,7 However, in a new study analyzing only a subset of young patients (<55 years old) who presented with MI, those with MINOCA had significantly lower rates of cardiac risk factors in comparison to those with MI-CAD. 8 The epidemiological and risk factors for MINOCA are summarized in ►Table 2.…”