Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

Andersson, Hanna; Pedersen, Frants; Engstrøm, Thomas; Helqvist, Steffen; Jensen, Morten Kvistholm; Jørgensen, Erik; Kelbæk, Henning; Räder, Sune B.E.W.; Saunamäki, Kari; Bates, Eric R.; Grande, Peer; Holmvang, Lene; Clemmensen, Peter

doi:10.1093/eurheartj/ehx491

Cited by 106 publications

(96 citation statements)

References 25 publications

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“…These stable patients typically have symptoms of chest pain suspected to be angina and/or abnormal stress testing, in the setting of no obstructive CAD at coronary angiography 1, 2. The definition of obstructive CAD varies between different guidelines or studies 3, 4, 5, 6, 7, 8, 9, 10. In general, “normal”‐appearing coronary arteries are defined as 0% luminal stenosis or <20%, and non–obstructive CAD (NOCAD) is defined as luminal stenosis >20% but <50% 3, 8, 9, 10.…”

Section: Inoca—prevalencementioning

confidence: 99%

“…The definition of obstructive CAD varies between different guidelines or studies 3, 4, 5, 6, 7, 8, 9, 10. In general, “normal”‐appearing coronary arteries are defined as 0% luminal stenosis or <20%, and non–obstructive CAD (NOCAD) is defined as luminal stenosis >20% but <50% 3, 8, 9, 10. However, some studies use a threshold of <70% for NOCAD,4 while anatomical scores consider a stenosis ≥50% as significant 5, 6, 11.…”

Section: Inoca—prevalencementioning

confidence: 99%

See 1 more Smart Citation

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

140

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Section: Inoca—prevalencementioning

confidence: 99%

Section: Inoca—prevalencementioning

confidence: 99%

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Herscovici

Sedlak

Wei

et al. 2018

JAHA

140

View full text Add to dashboard Cite

“…Inversely, the incidence of AMI increases with increasingly higher hs-cTn values at prese ntation. 28,29 It follows that rather sharply defined lower range hs-cTn cutoff values can be used to achieve an extremely high NPV but that defining the upper hs-cTn cutoff values to diagnose AMI is more gradual and less absolute. Studies to define the optimal upper hs-cTn cutoff to rule-in AMI are unique for each hs-cTn assay.…”

Section: High Sensitivity Cardiac Troponin Assaysmentioning

confidence: 99%

“…16 This algorithm assigns patients into 3 groups: (1) a rule-out group (60% of patients), (2) a rule-in group (17% of patients), and (3) an observe group with substantial diagnostic un certainty (23% of remaining patients). 29 Although this algorithm improves clinical decision making, still 22% in the rule-in group and 81% in the observe group eventually do not have AMI. Most patients in the observe group are diagnosed as having non-coronary myocardial or non-cardiac disease, although preexisting CAD may be frequently present.…”

Section: Attempts To Improve the Specificity Of Hs-ctn Assaysmentioning

confidence: 99%

“…Most patients in the observe group are diagnosed as having non-coronary myocardial or non-cardiac disease, although preexisting CAD may be frequently present. 29,42,43 Increased biomarker levels should always be evaluated in light of the clinical scenario, patient characteristics, and pretest probabilities because isolated (mildly) abnormal hs-cTn levels are insufficient to diagnose AMI. 6 On the other hand, higher baseline hs-cTn and delta values may be indicative of acute (ongoing) myocardial injury and increase the probability of AMI.…”

Section: Attempts To Improve the Specificity Of Hs-ctn Assaysmentioning

confidence: 99%

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Diagnostic evaluation of chest pain

Smulders¹

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Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers

Quesada,

Yildiz,

Henry

et al. 2023

JAMA Netw Open

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ImportanceThe clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown.ObjectiveTo assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimickers as compared with obstructive disease.Design, Setting, and ParticipantsA retrospective analysis of a prospective registry-based cohort study of consecutive STEMI activations at 3 regional Midwest STEMI programs. STEMI without a culprit artery and elevated troponin levels were categorized as MINOCA (absence of coronary artery stenosis &gt;50% and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) or MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy). Data were analyzed from March 2003 to December 2020.Main Outcomes and MeasuresAdjusted Cox regression analysis was used to assess 5-year mortality risk in STEMI presenting with MINOCA and MINOCA mimickers in comparison with obstructive disease.ResultsAmong 8560 consecutive patients with STEMI, mean (SD) age was 62 (14) years, 30% were female (2609 participants), and 94% were non-Hispanic White (4358 participants). The cohort included 8151 patients with STEMI due to obstructive disease (95.2%), 120 patients with MINOCA (1.4%), and 289 patients with MINOCA mimickers (3.8%). Patients were followed up for a median (IQR) of 7.1 (3.6-10.7) years. Patients with MINOCA and MINOCA mimickers were less likely to be discharged with cardiac medications compared with obstructive disease. At 5-year follow-up, mortality in STEMI presenting with obstructive disease (1228 participants [16%]) was similar to MINOCA (20 participants [18%]; χ21 = 1.1; log-rank P = .29) and MINOCA mimickers (52 participants [18%]; χ21 = 2.3; log-rank P = .13). In adjusted Cox regression analysis compared with obstructive disease, the 5-year mortality hazard risk was 1.93 times higher in MINOCA (95% CI, 1.06-3.53) and similar in MINOCA mimickers (HR, 1.08; 95% CI, 0.79-1.49).Conclusions and RelevanceIn this large multicenter cohort study of consecutive clinical patients with STEMI, presenting with MINOCA was associated with a higher risk of mortality than obstructive disease; the risk of mortality was similar in patients with MINOCA mimickers and obstructive disease. Further investigation is necessary to understand the pathophysiologic mechanisms involved in this high-risk STEMI population.

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Long-term survival and causes of death in patients with ST-elevation acute coronary syndrome without obstructive coronary artery disease

Abstract: STE-ACS patients without obstructive CAD had a long-term risk of death similar to or higher than patients with obstructive CAD. Causes of death were less often cardiovascular. This suggests that STE-ACS patients without obstructive CAD warrant medical attention and close follow-up.

Cited by 106 publications

References 25 publications

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

Diagnostic evaluation of chest pain

Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers

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