Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease

Dokainish, Hisham; Pillai, Manu; Murphy, Sabina A.; DiBattiste, Peter M.; Schweiger, Marc J.; Lotfi, Amir; Morrow, David A.; Cannon, Christopher P.; Braunwald, Eugene; Lakkis, Nasser; Investigators, Tactics-Timi

doi:10.1016/j.jacc.2004.09.056

Cited by 114 publications

(27 citation statements)

References 26 publications

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“…In contrast, patients with vasospasm more often reported recurrent angina, illicit drug use, and pregnancy‐related complications. With 1 in 10 young patients with AMI diagnosed with MINOCA,3, 4, 5, 6, 7, 8 our findings highlight both the challenges and the importance of pursuing a systematic approach to identify the underlying cause (coronary‐ischemic, non–coronary‐ischemic or nonischemic, or noncardiac) 13, 36…”

Section: Discussionmentioning

confidence: 89%

“…Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) constitute 6% to 14% of all those with acute myocardial infarction (AMI) 1, 2, 3, 4, 5, 6, 7, 8. Recent evidence demonstrates that patients with MINOCA are distinct from patients with AMI with the classic culprit lesion—namely, >50% plaque‐mediated occlusion of the coronary artery (myocardial infarction due to coronary artery disease [MI‐CAD])—by having lower prevalence of the traditional cardiac risk factors and a lower but clinically significant annual mortality rate 1, 5, 6.…”

Section: Introductionmentioning

confidence: 99%

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Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

Safdar

Spatz

Dreyer

et al. 2018

JAHA

344

233

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BackgroundWe compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI‐CAD]) and among patients with MINOCA by sex and subtype.Methods and ResultsBetween 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI‐CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1‐ and 12‐month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI‐CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29–7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI‐CAD patients (3.0% versus 1.3%; P=0.036). Women with MI‐CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One‐ and 12‐month mortality with MINOCA and MI‐CAD was similar (1‐month: 1.1% and 1.7% [P=0.43]; 12‐month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12‐month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06).ConclusionsYoung patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI‐CAD patients.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

Safdar

Spatz

Dreyer

et al. 2018

JAHA

344

233

View full text Add to dashboard Cite

show abstract

“…The likelihood of nonobstructive disease was higher in younger patients with MI, women, and patients of African race, consistent with previously published data. 10,15,16 In-hospital mortality with MINOCA was significantly lower than with MI-CAD. In models evaluating the risk of in-hospital mortality, we identified interactions between sex and obstructive CAD status, age and sex, and age and obstructive CAD status.…”

Section: Discussionmentioning

confidence: 92%

Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines)

Smilowitz

Mahajan

Roe

et al. 2017

Circ: Cardiovascular Quality and Outcomes

273

188

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Background— Sex differences in early mortality after myocardial infarction (MI) vary by age. MI with nonobstructive coronary arteries (MINOCA [<50% stenosis]) is more common among younger patients and women, and MINOCA has a better prognosis than MI with obstructive coronary artery disease (MI-CAD). The relationship between age, sex, and obstructive CAD status and outcomes post-MI has not been established. Methods and Results— Adults who underwent coronary angiography for acute ST-segment–elevation and non–ST-segment–elevation MI in the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines) from 2007 to 2014 were identified. Patients with cardiac arrest, thrombolytic therapy, prior revascularization, or missing demographic or angiographic data were excluded. The primary outcome was all-cause, in-hospital mortality. Secondary outcomes included major adverse cardiovascular events. Demographics, clinical history, presentation, and in-hospital treatments were compared by sex and CAD status (MI-CAD or MINOCA). Mortality and major adverse cardiovascular outcomes were analyzed by age, sex, and CAD status. Among 322 523 patients with MI, MINOCA occurred in 18 918 (5.9%). MINOCA was more common in women than men (10.5% versus 3.4%; P <0.0001), and women had higher mortality than men overall (3.6% versus 2.4%; P <0.0001). In-hospital mortality was lower after MINOCA than MI-CAD (1.1% versus 2.9%; P <0.0001). Among patients with MI-CAD, women had higher mortality than men (3.9% versus 2.4%; P <0.0001) while no sex difference in mortality was observed with MINOCA (1.1% versus 1.0%; P =0.84). The higher risk of post-MI death among women with MI-CAD was most pronounced at younger ages. Conclusions— MINOCA was associated with lower mortality than MI-CAD. Higher risk of post-MI death among women in comparison to men was restricted to patients with MI-CAD.

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“…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%

“…MINOCA is found in roughly 6% of AMI patients4; however, there is large variability in its reported prevalence, with a range of 3.5% to 15%,3, 4, 5, 6, 7, 8, 9, 10, 11 possibly attributable to differences in the studied populations and heterogeneity in its definition. MINOCA is also more common in younger patients and women 3, 4, 5, 6, 7.…”

Section: Introductionmentioning

confidence: 99%

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

Tamis-Holland

Jneid

2018

JAHA

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Prognostic implications of elevated troponin in patients with suspected acute coronary syndrome but no critical epicardial coronary disease

Abstract: Elevated troponin in ACS is associated with a higher risk for death or reinfarction, even among patients who do not have significant angiographic CAD. The mechanisms conferring this adverse prognosis merit further study.

Cited by 114 publications

References 26 publications

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry–GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines)

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

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