Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up

Abdu, Fuad A; Liu, Lu; Mohammed, Abdul-Quddus; Luo, Yanru; Xu, Siling; Auckle, Ranshaka; Xu, Yawei; Che, Wenliang

doi:10.1016/j.ijcard.2019.02.036

Cited by 69 publications

(66 citation statements)

References 28 publications

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“…3 Patients with CE myocardial infarction suffer from significantly increased 5-year risk of adverse cardiac and cerebrovascular events, which may be as high as 27%. 2 Age greater than 60 years, female gender, reduced left ventricular ejection fraction and atrial fibrillation are independent risk factors for major adverse cardiovascular events in patients with non-atherosclerotic myocardial infarction, 4 emphasising the importance of recognising CE and associated prognostic factors. CE diagnosis may be suspected on retrospective evaluation of coronary angiogram when the occlusive thrombus burden is disproportionate to the degree of atherosclerosis, no or minimal atherosclerosis in other coronary territories, or there is evidence of concomitant systemic embolisation in other arterial beds, for example, cerebral, mesenteric, retinal or in extremities.…”

Section: Discussionmentioning

confidence: 99%

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Shabbir

Shaukat²,

Sullenberger

et al. 2019

BMJ Case Rep

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A 77-year-old woman without traditional risk factors for coronary artery disease (CAD) underwent coronary CT-angiography for evaluation of palpitations after negative Holter monitoring and non-diagnostic ECG exercise stress test. Coronary artery calcium score was reported zero; 1 day later, she was admitted with anterior-wall ST elevation myocardial infarction. Acute left anterior descending artery thrombus was treated with mechanical thrombectomy and Percutaneous Coronary Intervention (PCI). Interestingly, the coronary arteries were angiographically normal. During hospitalisation, paroxysmal atrial fibrillation was noted followed by initiation of anticoagulation. Echocardiogram did not show thrombus or atrial shunt. Cardioversion with Sotalol was successful. Myocardial infraction was most likely cardioembolic secondary to paroxysmal atrial fibrillation—consistent with longstanding history of palpitations. Accounting for 3% of acute coronary syndromes, coronary embolism is treated with therapeutic anticoagulation for at least 3 months irrespective of cause and carries a higher risk of adverse cardiovascular events.

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Section: Discussionmentioning

confidence: 99%

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Shabbir

Shaukat²,

Sullenberger

et al. 2019

BMJ Case Rep

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“…The win ratio for all-cause death remained higher in patients with OCAD, while that for MI and HF hospitalizations was similar PLOS ONE between the groups. Rather surprisingly, in a recent Chinese study, the incidence of non-fatal MI or HF was extremely low even in patients with MINOCA over a 1-year follow-up [9]. Elevated cardiac biomarkers are known to be associated with worse prognosis in a variety of clinical scenarios.…”

Section: Follow-up Mortality and Mace After Propensity Score Matchingmentioning

confidence: 95%

“…The pathophysiology of MINOCA / INOCA is complex with several possible underlying mechanisms [2,[4][5][6]. Patients with MINOCA are usually younger and more often females; however, the distribution of the traditional cardiovascular risk factors and comorbidities varies between analyses [5,[7][8][9]. Data on clinical profiles of patients with INOCA presenting with ACS are scarce [3,10].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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

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“…One research reported poor prognosis in elderly MINOCA patients undergoing CAG, with 1/5 presenting serious adverse events in 12 months [12]. A recent study on Chinese MINOCA patients found that although the incidence of MACE was lower than in MI-CAD patients, there was no significant difference in mortality after 1 year of follow-up [49]. More notably, the results from the SWEDEHEART registry showed that 23.9% of MINOCA patients experienced MACE over a 4-year follow-up [50].…”

Section: Prognosismentioning

confidence: 99%

“…A recent study [56] on prognostic risk factors for MINOCA during a 4.5-year follow-up reported that age, hypertension, diabetes, smoking, previous stroke, MI, peripheral vascular disease, COPD, decreased LV ejection fraction, lower total cholesterol levels, and higher creatinine levels were independent predictors of MACE. Current research on Chinese MINOCA patients reports that the independent predictors of MACE in MINOCA patients are older age, female sex, atrial fibrillation, and reduced LV ejection fraction [49]. Considering the variability in the MINOCA population, it would be an advantage to be able to determine MINOCA patients at risk of CV outcomes by means of clinical risk predictors.…”

Section: Predictors Of Outcomementioning

confidence: 99%

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

et al. 2020

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Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains a puzzling clinical entity that is characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis < 50%). Major advances in understanding this condition have been made in recent years. The precise pathogenesis is poorly understood and is being studied and examined further. Guidelines indicate that MINOCA is a group of heterogeneous diseases with different mechanisms of pathology. Since there are multiple possible pathological mechanisms, it is not certain that the classical secondary prevention and treatment strategy for MI with obstructive coronary artery disease (MI-CAD) is optimal for MINOCA patients. The prognosis and predictors for MINOCA patients remain unclear. Although the prognosis is slightly better for MINO-CA patients than for MI-CAD patients, MINOCA isn't always benign. The aim of this paper was to review the literature and evaluate MINOCA epidemiology, clinical features, etiology, diagnosis, treatment, and prognosis.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up

Cited by 69 publications

References 28 publications

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

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

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up

Cited by 69 publications

References 28 publications

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

Paroxysmal atrial fibrillation presenting as anterior wall STEMI in an elderly woman

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

Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA): A Review of the Current Position

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) in Chinese patients: Clinical features, treatment and 1 year follow-up