Myocardial infarction with nonobstructive coronary arteries

Sá, Fernando Montenegro; Ruivo, Catarina; Santos, L Graça; Antunes, Alexandre; Saraiva, Fátima; Soares, Fabiana; Morais, João

doi:10.1097/mca.0000000000000619

Cited by 27 publications

(11 citation statements)

References 29 publications

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“…In light of the difficulty in establishing an etiological diagnosis in all patients, and the clinical dilemma in identifying which patients would require a closer follow-up and more aggressive secondary prevention therapy, the prognostic stratification is crucial. Numerous studies have proposed several prognostic markers, but with heterogeneous results -female sex, history of smoking, atrial fibrillation, previous AMI, ST-segment elevation at admission, 18,23 age, diabetes, previous stroke, peripheral arterial disease, chronic obstructive pulmonary disease, neoplasms, reduced ejection fraction, levels of LDL, creatinine and C-reactive protein, 18 and number of coronary arteries with stenosis less than 50%. 24 The GRACE score is an ideal prognostic stratification tool in these patients.…”

Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries – Stratifying the Risk of a “new” Clinical Entity using an “Old” Tool

Carvalho¹,

Caçoilo²,

Afreixo³

et al. 2021

International Journal of Cardiovascular Sciences

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Background: Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives:To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population.Methods: This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) -a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results:Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion:The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

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Section: Discussionmentioning

confidence: 99%

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries – Stratifying the Risk of a “new” Clinical Entity using an “Old” Tool

Carvalho¹,

Caçoilo²,

Afreixo³

et al. 2021

International Journal of Cardiovascular Sciences

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“…In the absence of any clinically overt specific cause for the acute presentation, the term myocardial infarction with nonobstructive coronary arteries (MINOCA) is used to classify this condition ( 2 ). Conditions frequently associated with such an entity include Takotsubo cardiomyopathy, myocarditis, and cardiac emboli ( 3 ). There is an important overlap between the diagnostic criteria for MINOCA and clinically suspected myocarditis, the diagnosis first assumed in our patient.…”

Section: Discussionmentioning

confidence: 99%

Circulating Heterophile Antibodies Causing Cardiac Troponin Elevation

et al. 2020

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“…The KAMIR-NIH study [42] concluded that, in MINOCA patients, old age, traditional symptoms, STE on ECG, Killip Class IV, and diabetes were independent predictors of all-cause death at the 2-year follow-up. Another study [55] revealed that female sex, younger age, STE, atrial fibrillation, and a history of previous MI were independent predictors of MINOCA. 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.…”

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 nonobstructive coronary arteries

Abstract: MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. Despite lower mortality than MICAD, the commonly attributed low-risk classification for MINOCA may be erroneous.

Cited by 27 publications

References 29 publications

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries – Stratifying the Risk of a “new” Clinical Entity using an “Old” Tool

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries – Stratifying the Risk of a “new” Clinical Entity using an “Old” Tool

Circulating Heterophile Antibodies Causing Cardiac Troponin Elevation

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

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