The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

Abstract

Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

Hyperuricemia Predicts Adverse Outcomes After Myocardial Infarction With Non-obstructive Coronary Arteries

“…Hyperuricemia also independently predicted the risk of mortality and MACE in patients who underwent cardiac revascularization and cardiac valve surgery (37). Two recent MINOCA studies reported that renal impairment was associated with mortality in MINOCA patients (38,39), the latter study also found that every third patient with MINOCA is diagnosed with impaired kidney function, which implies that the uric acid may play a significant role related to the extent of impaired cardiovascular and/or renal hemodynamics in patients with MINOCA. To our knowledge, no prior study has evaluated the association between hyperuricemia and MINOCA and its impact on clinical outcomes.…”

The Comparison of Predicting Factors and Outcomes of MINOCA and STEMI Patients in the 5-Year Follow-Up

“…However, they differentiated two subgroups with eGFR < 60 and ≥ 60 mL/min/1.73 m 2 . At 12 months, the all-cause death was 26.42% vs. 7.20% ( p = 0.0004), and after 36 months, it was 33.96% vs. 9.6% ( p < 0.0001) [ 26 ]. In our study, only 3.6% of patients had chronic kidney disease.…”

Sex-Related Differences in the Prevalence of Classical, Non-Classical Risk Factors and Management of the Chronic Coronary Syndrome

“…The main factors are presented in Table 1. COPD [9] Obstructive sleep apnea [10] Past stroke [11] Peripheral artery disease [12] Chronic kidney disease [13,14] Anemia [15] Hyperuricemia [16][17][18] Hyperfibrinogenemia [19] Thyroid hormone dysfunction [20] Rheumatoid arthritis [21] Psychiatric disorders [22] * Sexual disorders [23] * Socioeconomic factors [24] * Pregnancy and reproduction-related disease [25,26] *…”