Clinical presentation and 3-year outcomes of patients with acute coronary syndromes and non-obstructive coronary arteries on angiography

Abstract

Background With the emerging interest in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), there is a need to define an even broader group of patients with the syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA). There are limited data on the clinical characteristics and prognoses of such patients who present with symptoms of acute coronary syndrome (ACS) and undergo urgent coronary angiography that reveals no significant lesions. The aim of this observational study was to compare patients with ACS INOCA and those with ACS with obstructive coronary artery disease (OCAD) both within unadjusted cohorts and with propensity score matched controls. Methods and results This observational study was based on the data from the Polish National Registry of Invasive Cardiology Procedures. Of 9744 patients included, 7624 had OCAD and 2120 had ACS INOCA. In unadjusted cohorts, the overall survival and incidence of major adverse cardiovascular events (MACE: death, cardiac arrest, myocardial infarction, stroke, and heart failure hospitalization) until 36 months were higher in patients with ACS OCAD. Following propensity matching, higher win ratios of death (p = 0.02), additional revascularizations by percutaneous coronary intervention or coronary artery bypass graft surgery (p<0.001), and cardiac hospitalization (p<0.001) were observed in these patients. In contrast, the win ratios of myocardial infarction (p = 0.74), heart failure hospitalization (p = 0.86), and MACE (p = 0.07) were not significantly different between the groups. Conclusions The prognosis of patients with ACS INOCA was more favorable than that of patients with ACS OCAD; however, the differences diminished after adjustments for the initial clinical

Non-vitamin K Antagonist Oral Anticoagulant, Warfarin, and ABC Pathway Adherence on Hierarchical Outcomes: Win Ratio Analysis of the COOL-AF Registry

“…Previous studies utilized only matched pairs approach in the retrospective cohort analysis. 42,43 The rationale behind selectively applying the matched pairs approach might be the nature of the retrospective cohort that required matching to mitigate the bias from a nonrandomized design. We were also aware of this potential bias, so we employed three methods of Win Ratio application, which were unmatched approach, matched pairs approach, and conventional Win Ratio on propensity-matched population.…”

Acute Heart Failure Due to Multi-vessel Coronary Spasm

“…However, the possibility of MINOCA in the present case cannot be completely ruled out, since the limited interval between blood drawing may have missed the maximal rise in troponin levels. Although MINOCA-related HF has been reported in a small percentage of patients with MINOCA (17)(18)(19), the frequency of coronary spasms in MINOCA-related HF is not well understood. Further multicenter registries should clarify the extent to which coronary spasms are involved in HF associated with MINOCA.…”

Evaluation of the causes of sex disparity in heart failure trials

“…This has been hypothesised to reduce lipid accumulation and delay development of coronary plaques through enhanced wall shear stress 12. Women, when presenting with an acute coronary syndrome, are less likely to have extensive coronary disease or functionally significant coronary artery stenoses15 16; therefore, making them less likely to develop ICM. Furthermore, oestradiol has been hypothesised to play a crucial role in preventing, or delaying the onset of, obstructive coronary artery disease in women.…”