Outcome after myocardial infarction without obstructive coronary artery disease

Abstract

ObjectiveThe medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).MethodsWe performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome—Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.ResultsOf the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.ConclusionsMINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.

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

“…In 322,523 AMI patients enrolled in the ACTION Registry-GWTG, the incidence of MINOCA was 5.9% [6]. In 8,305 patients presenting with MI in the ANZACS-QI program trials, 10.8% received a diagnosis of MINOCA [7]. A large clinical COAPT study investigating AMI patients reported that MINOCA was identified in 5.8% of the patients with MI [3].…”

“…A large-scale, long-term Italian study showed that the incidence of MACE in MI-CAD patients was higher than in MINOCA patients after 26 months of follow-up, but that the rates of mortality, cardiogenic readmission, and stroke were similar [45]. A 2-year follow-up study indicated that MINOCA is widespread, with about half the MACE accompanying MI-CAD, and an all-cause mortality rate of 4.9%, mainly non-CV (4.5%) [7]. Another 3.8-year follow-up study [46] disclosed that the all-cause mortality rate for MINOCA was 12.1%, with a CV mortality rate of 5.3%, a respiratory mortality rate of 1.3%, and a tumor mortality rate of 3.1%.…”

Heartbeat: Improving acute myocardial infarction outcomes in women

“…In a study from New Zealand3, MINOCA accounted for about 11% of patients in a nationwide cohort study of over 8000 AMI patients. In those with obstructive coronary artery disease, all-cause mortality at 2 years was 7.9% compared with 4.9% in those with MINOCA.…”

“…The link between the New Zealand study on MINOCA3 and the UK based study1 on sex differences in AMI treatment is evident in the editorial by Mehta and Beltrame4 in which they raise the question: ‘Why do young women predominate in MINOCA population? Even in the settings of stable angina and ischaemic heart disease, women are more likely to have the finding of no obstructive CAD on angiography.’ They go on to answer that: ‘Coronary microvascular dysfunction from either abnormal vasodilatory capacity or from microvascular spasm is highly prevalent in this group.…”

Myocardial infarction with non-obstructive coronary arteries: a humbling diagnosis in 2018

“…The study by Williams et al 6 reported in Heart provide important insights into the prognosis of patients with MINOCA. Similar to previous studies, they compared the major adverse cardiovascular events (MACE; all cause death or recurrent non-fatal MI) of patients with MINOCA (n=897) with those with MI associated with obstructive CAD (n=7408).…”