Myocardial Infarction Without Obstructive Coronary Artery Disease is Not a Benign Condition (ANZACS-QI 10)

Barr, P.; Harrison, W. R. E.; Smyth, David; Flynn, C.; Lee, Mildred; Kerr, Andrew

doi:10.1016/j.hlc.2017.02.023

Cited by 103 publications

(93 citation statements)

References 33 publications

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“…Several previous investigations have demonstrated that MINOCA is associated with adverse outcome . A recent meta‐analysis based on 1924 MINOCA patients from four studies demonstrated a 1‐year all‐cause mortality rate of 4.7% which is close to the all‐cause mortality observed in our cohort.…”

Section: Discussionsupporting

confidence: 84%

“…Data from observational studies and systematic reviews indicate that MINOCA patients are at increased risk of adverse outcome . However, there are limited amount of data closer investigating cardiovascular morbidity in MINOCA , and cause‐specific mortality has never been studied to the best of our knowledge. Such information is necessary for a closer understanding of potential disease mechanisms that distinguish MINOCA from MI with significant coronary artery disease (MI‐CAD), and that might require differentiated patient management.…”

Section: Introductionmentioning

confidence: 99%

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Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries

et al. 2018

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Eggers KM, Hjort M, Baron T, Jernberg T, Nordenskj€ old AM, Tornvall P, Lindahl B (). Morbidity and cause-specific mortality in first-time myocardial infarction with nonobstructive coronary arteries. J Intern Med 2019; 285: 419-428.Background. Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is receiving increasing interest as a prognostically adverse entity distinct from myocardial infarction with significant coronary artery disease (MI-CAD). However, data are still limited regarding long-term cardiovascular morbidity and cause-specific mortality in MINOCA.Methods. This is a registry-based cohort study using data from patients admitted to Swedish coronary care units. We investigated various nonfatal outcomes (recurrent MI, hospitalization for heart failure or stroke) and fatal outcomes (cardiovascular, respiratory or cancer-related mortality) in 4069 patients without apparent acute cardiovascular disease, used as non-MI controls, 7266 patients with first-time MINOCA and 69 267 patients with first-time MI-CAD.Results. Almost all event rates (median follow-up 3.8 years) increased in a stepwise fashion across the three cohorts [rates of major adverse events (MAE; composite of all-cause mortality, recurrent MI, hospitalization for heart failure or stroke): n = 268 (6.6%), n = 1563 (21.5%), n = 17 777 (25.7%), respectively]. Compared to non-MI controls, MINOCA patients had an adjusted hazard ratio (HR) of 2.12 (95% confidence interval 1.84-2.43) regarding MAE. MINOCA patients had a substantial risk of cardiovascular mortality and the highest numerical risks of respiratory and cancer-related mortality. Male sex, previous heart failure and chronic obstructive pulmonary disease had a stronger prognostic impact in MINOCA than in MI-CAD. Female MINOCA patients with atrial fibrillation were at particular risk.Conclusions. Patients with first-time MINOCA have a considerable risk of adverse events. This stresses the need for a comprehensive search of the cause of MINOCA, thorough treatment of underlying disease triggers and close follow-up.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries

et al. 2018

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“…MINOCA is also more common in younger patients and women 3, 4, 5, 6, 7. This explains to a large extent why the current study, examining adult AMI patients aged <55 years, with a 2:1 enrollment ratio of women to men, reported a higher prevalence of MINOCA than earlier reports.…”

Section: Introductioncontrasting

confidence: 52%

“…A sizeable minority of patients with AMI are found to have MINOCA 3, 4, 5, 6, 7, 8, 9, 10, 11. Unfortunately, some physicians fail to realize that the absence of obstructive coronary arteries does not exclude the possibility of an AMI.…”

Section: Introductionmentioning

confidence: 99%

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Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

Tamis-Holland

Jneid

2018

JAHA

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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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Myocardial Infarction Without Obstructive Coronary Artery Disease is Not a Benign Condition (ANZACS-QI 10)

Cited by 103 publications

References 33 publications

Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries

Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

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

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