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Tsukada YT, Aoki-Kamiya C, Mizuno A, Nakayama A, Ide T, Aoyama R, Honye J, Hoshina K, Ikegame T, Inoue K, Bando YK, Kataoka M, Kondo N, Maemura K, Makaya M, Masumori N, Mito A, Miyauchi M, Miyazaki A, Nakano Y, Nakao YM, Nakatsuka M, Nakayama T, Oginosawa Y, Ohba N, Otsuka M, Okaniwa H, Saito A, Saito K, Sakata Y, Harada-Shiba M, Soejima K, Takahashi S, Takahashi T, Tanaka T, Wada Y, Watanabe Y, Yano Y, Yoshida M, Yoshikawa T, Yoshimatsu J, Abe T, Dai Z, Endo A, Fukuda-Doi M, Ito-Hagiwara K, Harima A, Hirakawa K, Hosokawa K, Iizuka G, Ikeda S, Ishii N, Izawa KP, Kagiyama N, Umeda-Kameyama Y, Kanki S, Kato K, Komuro A, Konagai N, Konishi Y, Nishizaki F, Noma S, Norimatsu T, Numao Y, Oishi S, Okubo K, Ohmori T, Otaki Y, Shibata T, Shibuya J, Shimbo M, Shiomura R, Sugiyama K, Suzuki T, Tajima E, Tsukihashi A, Yasui H, Amano K, Kohsaka S, Minamino T, Nagai R, Setoguchi S, Terada K, Yumino D, Tomoike H. JCS/JCC/JACR/JATS 2024 Guideline on Cardiovascular Practice With Consideration for Diversity, Equity, and Inclusion. Circ J 2025; 89:658-739. [PMID: 39971310 DOI: 10.1253/circj.cj-23-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Affiliation(s)
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | - Rie Aoyama
- Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center
| | - Junko Honye
- Cardiovascular Center, Kikuna Memorial Hospital
| | | | | | - Koki Inoue
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka Metropolitan University
| | - Yasuko K Bando
- Department of Molecular Physiology and Cardiovascular Biology, Mie University Graduate School of Medicine
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine
| | - Asako Mito
- Division of Maternal Medicine, Center for Maternal-Fetal-Reproductive Medicine, National Center for Child Health and Development
| | - Mizuho Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Department of Adult Congenital Heart Disease, Seirei Hamamatsu General Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoko M Nakao
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Mikiya Nakatsuka
- Faculty of Health Sciences, Okayama University Graduate School of Medicine
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | | | - Maki Otsuka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Hiroki Okaniwa
- Department of Technology, Gunma Prefectural Cardiovascular Center
| | - Aya Saito
- Department of Surgery, Division of Cardiovascular Surgery, Yokohama City University, Graduate School of Medicine
| | - Kozue Saito
- Department of Neurology, Stroke Center, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | | | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Toshihiro Tanaka
- Department of Human Genetics and Disease Diversity, Tokyo Medical and Dental University
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
| | | | - Yuichiro Yano
- Department of General Medicine, Juntendo University Faculty of Medicine
| | - Masayuki Yoshida
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Toru Yoshikawa
- Research Center for Overwork-Related Disorders (RECORDs), National Institute of Occuatopnal Safety and Health, Japan (JNIOSH)
| | - Jun Yoshimatsu
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Takahiro Abe
- Department of Rehabilitation Medicine, Hokkaido University Hospital
| | - Zhehao Dai
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Ayaka Endo
- Department of Cardiology, Tokyo Saiseikai Central Hospital
| | - Mayumi Fukuda-Doi
- Department of Data Science, National Cerebral and Cardiovascular Center
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Kumamoto University
| | | | | | - Satoshi Ikeda
- Stroke and Cardiovascular Diseases Support Center, Nagasaki University Hospital
| | - Noriko Ishii
- Department of Nursing, Sakakibara Heart Institute
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | | | - Sachiko Kanki
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University
| | - Katsuhito Kato
- Department of Hygiene and Public Health, Nippon Medical School
| | - Aya Komuro
- Department of Geriatric Medicine, The University of Tokyo Hospital
| | - Nao Konagai
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Yuto Konishi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Yoshimi Numao
- Department of Cardiology, Itabasih Chuo Medical Center
| | | | - Kimie Okubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine Itabashi Hospital
| | | | - Yuka Otaki
- Department of Radiology, Sakakibara Heart Institute
| | | | - Junsuke Shibuya
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Mai Shimbo
- Department of Cardiovascular Medicine, Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo
| | - Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | | | - Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Emi Tajima
- Department of Cardiology, Tokyo General Hospital
| | - Ayako Tsukihashi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | | | - Soko Setoguchi
- Division of Education, Department of Medicine, Rutgers Robert Wood Johnson Medical School
- Division of Cardiovascular Disease and Hypertension, Department of Medicine, Rutgers Robert Wood Johnson Medical School
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Xia J, Deng C, Yang C, Lu Z, Wang S, Zhang L, Liu Z, Zhang W, Zhao R, Xu G, Shi B. Clinical characteristics and prognosis of myocardial infarction with nonobstructive coronary arteries evaluated by optical coherence tomography. Sci Rep 2025; 15:9962. [PMID: 40121212 PMCID: PMC11929927 DOI: 10.1038/s41598-025-91865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Accepted: 02/24/2025] [Indexed: 03/25/2025] Open
Abstract
Myocardial infarction with nonobstructive coronary artery (MINOCA) is a heterogeneous disease with different pathophysiological mechanisms and prognosis. In recent years, it has been found that the incidence of major cardiovascular adverse events in MINOCA is similar to that of myocardial infarction with coronary artery disease (MI-CAD), and it is difficult to clarify the pathogenesis of both through coronary angiography (CAG). Therefore, the aim of this study is to investigate the clinical features, plaque characteristics and prognosis of patients with MINOCA and MI-CAD through optical coherence tomography (OCT). A total of 553 culprit lesions from AMI patients who underwent CAG and OCT were retrospectively analysed. Patients were subsequently divided into two groups: the MINOCA group and the MI-CAD group. The clinical characteristics, plaque characteristics and prognosis of the two groups were compared. The primary endpoint was defined as a composite of major adverse cardiac events (MACE), including cardiac death, non-fatal myocardial infarction, target lesion revascularization, stroke, and rehospitalisation for angina or heart failure. (1) Patients with MINOCA exhibited a lower incidence of ST-segment elevated myocardial infarction (STEMI) and a less frequent history of combined drug-eluting stent (DES) compared to those with MI-CAD. Additionally, they demonstrated lower levels of low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG), peak troponin T (peak TnT) and peak creatine kinase (peak CK). The MINOCA group had more lesions in the left anterior descending (LAD) and fewer in the left circumflex (LCX). Additionally, they demonstrated a lower prevalence of multibranch vasculopathy and a diminished post-discharge use of aspirin, P2Y12 receptor inhibitors, beta-blockers, angiotensin converting enzyme inhibitor/angiotensin receptor blockers (ACEI/ARBs), and a higher proportion of conservative treatment compared to DES. The frequency of plaque rupture, calcified plaque, cholesterol crystals, macrophages infiltration, microvessels, thin-cap fibroatheroma (TCFA), and thrombus were found to be lower in the MINOCA group than in the MI-CAD group, with these differences being statistically significant (P < 0.05); (2) No significant difference was observed in the incidence of MACE at 30-days and 1 year between patients in the MINOCA and MI-CAD groups (P > 0.05). Compared with MI-CAD patients, MINOCA patients had fewer high-risk plaques on OCT and were more likely to be treated conservatively, with lower rates of stenting and less post-discharge pharmacological treatment. Both groups had similar rates of MACE at 30-day and 1 year, highlighting the importance of individualising treatment for MINOCA patients. Patients with MINOCA who develop MACE are more likely to exhibit high-risk OCT plaque features, with macrophage infiltration identified as an independent risk factor. OCT plaque features such as plaque rupture, plaque erosion, cholesterol crystals, macrophages, microvessels, TCFA may have played different roles in the progression of the two groups of patients.
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Affiliation(s)
- Jie Xia
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chancui Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Caifeng Yang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zaili Lu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Sha Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Long Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijiang Liu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ranzun Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guanxue Xu
- Department of Cardiology, The Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China.
| | - Bei Shi
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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Khorasani N, Mohammadi Y, Sarpoli M, Kazemi T, Riahi SM. Understanding Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): a comprehensive meta-analysis of clinical characteristics, management, and prognosis compared to MI with the Obstructive Coronary Artery (MIOCA). BMC Cardiovasc Disord 2025; 25:143. [PMID: 40025434 PMCID: PMC11871625 DOI: 10.1186/s12872-025-04504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Accepted: 01/17/2025] [Indexed: 03/04/2025] Open
Abstract
BACKGROUND MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries) represents a unique subset of acute coronary syndrome, distinct from MIOCA (Myocardial Infarction with Obstructive Coronary Arteries) and a control group. This study systematically compares their prevalence, clinical characteristics, management strategies, and outcomes to improve understanding and treatment approaches. METHODS This systematic review and meta-analysis followed PRISMA guidelines across multiple databases up to 2024. STATA 17 was used for statistical analyses, and the Newcastle-Ottawa Scale was employed to assess study quality. RESULTS One-hundred and twelve studies, including 5,908,768 patients, were analyzed. The pooled prevalence of MINOCA among patients undergoing coronary angiography was 8.92% (95% CI: 8.90-8.94). MINOCA patients were generally younger, predominantly female, and more likely to present with atypical chest pain and dyspnea compared to MIOCA patients. Laboratory findings showed higher levels of CRP, BNP, and fibrinogen in MINOCA patients, suggesting inflammation and microvascular dysfunction as key mechanisms. In contrast, MIOCA patients had higher rates of diabetes and dyslipidemia, highlighting differences in pathophysiological processes. Medication use differed between the groups, with MINOCA patients more likely to be prescribed anticoagulants and β-blockers. Prognostically, MINOCA patients experienced significantly lower rates of adverse short- and long-term outcomes, including major adverse cardiac events (MACE) and cardiovascular death, compared to MIOCA patients. CONCLUSIONS This study demonstrated that patients with MINOCA have a better prognosis compared to those with MIOCA and are at a lower risk of serious cardiac events. Based on the findings of this study, we emphasize that microcirculation and vascular spasm are the main mechanisms involved in MINOCA. Considering these findings, it is suggested that a better management strategy for MINOCA patients can be established by precisely defining diagnostic criteria and focusing on anti-inflammatory treatments and risk factor control.
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Affiliation(s)
- Nahid Khorasani
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Yaser Mohammadi
- Department of Biochemistry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdiye Sarpoli
- Student Research Committee, Birjand University of Medical Sciences, Birjand, 9717853577, Iran
| | - Toba Kazemi
- Department of Community Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Seyed Mohammad Riahi
- Department of Community Medicine, School of Medicine, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Abumayyaleh M, Schlettert C, Materzok D, Mügge A, Hamdani N, Akin I, Aweimer A, El-Battrawy I. Age Variation in Patients with Troponin Level Elevation Without Obstructive Culprit Lesion or Suspected Myocardial Infarction with Non-Obstructive Coronary Arteries-Long-Term Data Covering over Decade. J Clin Med 2024; 13:7685. [PMID: 39768608 PMCID: PMC11676906 DOI: 10.3390/jcm13247685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Revised: 12/02/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025] Open
Abstract
Background/Objectives: Troponin level elevation without an obstructive culprit lesion is caused by heterogenous entities. The effect of aging on this condition has been poorly investigated. Methods: After screening 24,775 patients between 2010 and 2021, this study included a total of 373 patients with elevated troponin levels without an obstructive culprit lesion or suspected myocardial infarction with non-obstructive coronary arteries (MINOCAs) categorized into four age groups containing 78 patients (<51 years), 72 patients (51-60 years), 81 patients (61-70 years), and 142 patients (>70 years). This study analyzed the baseline characteristics, the in-hospital complications, in-hospital mortality, and the long-term outcomes. Results: The older patients exhibited a higher rate of major adverse cardiovascular in-hospital events than those of the other age groups (15.4% in the <51-year-old group vs. 36.1% in the 51-60-year-old group vs. 33.3% in the 61-70-year-old group vs. 47.2% in the >70-year-old group; p < 0.001). However, the rate of non-sustained ventricular tachycardia (nsVT) was higher in the 51-60-year-old patients than those of the other age groups (5.6% in the 51-60-year-old group vs. 1.3% in the 61-70-year-old group vs. 0.7% in the >70-year-old group; p = 0.027). At the 11-year follow-up, cardiovascular mortality was higher among the older patients compared to that of the younger patients (3.9% in the 61-70-year-old group vs. 4.2% in the >70-year-old group, p = 0.042), while non-cardiovascular mortality was comparable between the age groups. Conclusions: The older patients with troponin level elevation without an obstructive culprit lesion experienced a higher incidence of major adverse cardiovascular events during hospitalization compared to that of the younger groups. Additionally, higher cardiovascular mortality rates were revealed in the older patients at a long-term follow-up.
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Affiliation(s)
- Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
- European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research (DZHK)), Partner Site, 68167 Mannheim, Germany
| | - Clara Schlettert
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr-University Bochum, 44789 Bochum, Germany; (C.S.); (D.M.); (A.M.); (A.A.)
| | - Daniel Materzok
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr-University Bochum, 44789 Bochum, Germany; (C.S.); (D.M.); (A.M.); (A.A.)
| | - Andreas Mügge
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr-University Bochum, 44789 Bochum, Germany; (C.S.); (D.M.); (A.M.); (A.A.)
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, 44791 Bochum, Germany;
| | - Nazha Hamdani
- Institute of Physiology, Department of Cellular and Translational Physiology, Ruhr-University Bochum, 44801 Bochum, Germany;
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Assem Aweimer
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr-University Bochum, 44789 Bochum, Germany; (C.S.); (D.M.); (A.M.); (A.A.)
| | - Ibrahim El-Battrawy
- Institut für Forschung und Lehre (IFL), Department of Molecular and Experimental Cardiology, Ruhr-University Bochum, 44791 Bochum, Germany;
- Institute of Physiology, Department of Cellular and Translational Physiology, Ruhr-University Bochum, 44801 Bochum, Germany;
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Khattab E, Karelas D, Pallas T, Kostakis P, Papadopoulos CH, Sideris S, Patsourakos N, Kadoglou NPE. MINOCA: A Pathophysiological Approach of Diagnosis and Treatment-A Narrative Review. Biomedicines 2024; 12:2457. [PMID: 39595023 PMCID: PMC11592352 DOI: 10.3390/biomedicines12112457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 10/11/2024] [Accepted: 10/15/2024] [Indexed: 11/28/2024] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity characterized by the absence of significant coronary artery obstruction in epicardial arteries (<50%) on coronary angiography in the setting of acute myocardial infarction (AMI). This article aims to provide a narrative review of the pathophysiological mechanisms, diagnostic challenges, and prognosis associated with MINOCA based on pathophysiology regarding the atherosclerotic and non-atherosclerotic causes. Etiological factors, including thromboembolism, coronary artery spasm, spontaneous coronary artery dissection, coronary microvascular disease, and supply-demand mismatch, are addressed. Imaging modalities such as echocardiography, advances in coronary angiography like intravascular ultrasound (IVUS) and optical coherence tomography (OCT), cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) are also analyzed. MINOCA patients have a better short-term prognosis compared to those with obstructive coronary artery disease but face significant long-term risks, underscoring the need for precise diagnosis and management strategies. Elevated inflammatory markers and specific genetic predispositions are also associated with adverse outcomes in MINOCA. This review focused on MINOCA from a pathophysiological perspective on the diverse underlying mechanisms, the challenges in achieving accurate diagnosis, the importance of a tailored therapeutic approach and the necessity for further investigation of clinical outcomes.
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Affiliation(s)
- Elina Khattab
- Medical School, University of Cyprus, 2029 Nicosia, Cyprus
| | - Dimitrios Karelas
- 2nd Cardiology Department, “Korgialenio–Benakio” Red Cross Hospital, 11526 Athens, Greece
| | - Theofilos Pallas
- Department of Cardiology, “Tzaneio” General Hospital of Piraeus, 18536 Piraeus, Greece
| | - Panagiotis Kostakis
- Department of Cardiology, “Hippokration” General Hospital, 11527 Athens, Greece
| | | | - Skevos Sideris
- Department of Cardiology, “Hippokration” General Hospital, 11527 Athens, Greece
| | - Nikolaos Patsourakos
- Department of Cardiology, “Tzaneio” General Hospital of Piraeus, 18536 Piraeus, Greece
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Haertel F, Montag C, Kraeplin T, Lauer B, Memisevic N, Moebius-Winkler S, Schulze PC, Otto S. Management of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Germany: a single-center study on hospital resources and healthcare economics. Front Public Health 2024; 12:1407568. [PMID: 39416941 PMCID: PMC11480025 DOI: 10.3389/fpubh.2024.1407568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/27/2024] [Indexed: 10/19/2024] Open
Abstract
Background Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) present as a main feature ≤50% stenosis upon angiography despite clinical symptoms and biomarker elevation related to acute coronary syndrome. Due to broad availability of high sensitivity troponin testing as well as invasive and non-invasive imaging, this clinical entity receives increasing clinical awareness. Objective We aimed to investigate the in-hospital work flow and economic impact of MINOCA vs. MICAD (myocardial infarction with obstructive coronary artery disease) patients and related clinical outcomes in a single-center patient collective of a large university heart center in Germany. Methods We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017-2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography for acute coronary syndrome. Associated in-hospital costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained. Results After screening of 3,021 patients, we included 660 patients with acute coronary syndrome. Of those, 118 patients were attributed to the MINOCA-group. 542 patients presented with a "classical" myocardial infarction (MICAD group). MINOCA patients were less frail, more likely female, but showed no relevant difference in age or other selected comorbidities except for fewer cases of diabetes. In-hospital mortality (11% vs. 0%; p < 0.001) and 30-day mortality (17.3% vs. 4.2%; p < 0.001) after the index event were significantly higher in the "classical" myocardial infarction group (MICAD)- Despite a shorter overall length of hospital stay (9.5 ± 8.7 days vs. 12.3 ± 10.5 days, p < 0.01) with a significantly shorter duration of high care monitoring (intensive/intermediate care or chest pain units) (2.4 ± 2.1 days vs. 4.7 ± 3.3 days, p < 0.01) MINOCA patients consumed a relevant contingent of hospital resources. Thus, in a 12-months period a total sum of almost 300 days was attributed to high care monitoring for MINOCA patients with a mean difference of approximately 50% compared to patients with classical myocardial infarction. With average and median costs of 50% less per index, MINOCA treatment costs were lower compared to the MICAD group in the hospital reimbursement system of Germany. Consequently, MINOCA treatment was not associated with a relevant profit for these expanses and a relevant share of nearly 40% of the total costs was generated due to high care monitoring. Conclusion In light of lower mortality than MICAD and growing scarcity of staff, financial and capacity resources the clinical symptom complex of MINOCA should be put under particular consideration for refining care concepts and resource allocation.
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Affiliation(s)
- Franz Haertel
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Carolin Montag
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Thomas Kraeplin
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Bernward Lauer
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Nedim Memisevic
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Sven Moebius-Winkler
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - P. Christian Schulze
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
| | - Sylvia Otto
- Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena, Jena, Germany
- Herz - und Gefäßpraxis Gera, Gera, Germany
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Onuk T, Polat F, Yaylak B, Çalik AN, Eren S, Akyüz Ş. Prognostic Value of PRECİSE DAPT Score on Short- and Long-Term Outcomes in MINOCA Patients with Acute Coronary Syndrome. Arq Bras Cardiol 2024; 121:e20230791. [PMID: 39417489 PMCID: PMC11185829 DOI: 10.36660/abc.20230791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 02/15/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Myocardial infarction with non-obstructive coronary arteries (MINOCA) constitutes a significant subset of acute myocardial infarctions (AMI) with uncertain prognostic markers. Early risk assessment is crucial to identify MINOCA patients at risk of adverse outcomes. OBJECTIVES This study aimed to evaluate the predictive capacity of the PRECISE-DAPT score in assessing short- and long-term prognoses in MINOCA patients presenting with ST-segment elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI). METHODS Among 741 MINOCA patients, the PRECISE-DAPT score was computed to analyze its association with in-hospital and follow-up major adverse cardiovascular events (MACE). Parameters showing significance in MACE (+) groups underwent statistical analysis: univariate logistic regression for in-hospital events and univariate Cox regression for follow-up events. For statistical significance, a predefined level of α = 0.05 was adopted. Parameters demonstrating significance proceeded to multiple logistic regression for in-hospital events and multivariate Cox regression for follow-up events. RESULTS In-hospital MACE occurred in 4.1% of patients, while 58% experienced follow-up MACE. Hemoglobin levels and the PRECISE-DAPT Score were identified as independent parameters for in-hospital MACE. Furthermore, ejection fraction (EF%) and the PRECISE-DAPT Score emerged as independent predictors of follow-up MACE. CONCLUSIONS The study revealed that a higher PRECISE-DAPT score was significantly associated with increased risks of both in-hospital and long-term major adverse cardiovascular events in MINOCA patients presenting with acute coronary syndrome (ACS), underscoring the score's potential in risk stratification for this patient cohort. BACKGROUND _ PRECISE-DAPT score predicts MACE risk in MINOCA patients. BACKGROUND _ Hemoglobin level and PRECISE-DAPT score predict in-hospital MACE. BACKGROUND _ Ejection fraction and PRECISE-DAPT score predict long-term MACE.
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Affiliation(s)
- Tolga Onuk
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research HospitalIstanbulTurquiaDr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul – Turquia
| | - Fuat Polat
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research HospitalIstanbulTurquiaDr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul – Turquia
| | - Bariş Yaylak
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research HospitalIstanbulTurquiaDr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul – Turquia
| | - Ali Nazmi Çalik
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research HospitalIstanbulTurquiaDr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul – Turquia
| | - Semih Eren
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research HospitalIstanbulTurquiaDr. Siyami Ersek Thoracic and Cardiovascular Surgery Education Research Hospital, Istanbul – Turquia
| | - Şükrü Akyüz
- Okan University Faculty of Health ScienceIstanbulTurquiaOkan University Faculty of Health Science, Istanbul – Turquia
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8
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Chander Y, Duggal B, Soni S. Does the management of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) changes with advanced diagnostic workup beyond coronary angiography? Results from the "Evaluation of the clinical Profile, Investigations and Cardiac Imaging of the Patients with MINOCA (EPIC-MINOCA Study)". Egypt Heart J 2024; 76:96. [PMID: 39098941 PMCID: PMC11298506 DOI: 10.1186/s43044-024-00530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Evaluation of the patients with MINOCA and identifying the underlying aetiology remains challenging. However, investigation in most patients remains limited to coronary angiography (CAG). The study aimed to assess the clinical profile, investigations and cardiac imaging of the patients with MINOCA and its outcomes. RESULTS Out of 55 patients with MINOCA, CAG was normal in 16 (29.1%), while 39 (69.9%) had nonobstructive coronary artery disease. Of 55 patients, 34 had limited workup (Group 1) and only 21 had advanced workup (Group 2). In comparison to Group 1, Group 2 had a significantly higher association with the identification of possible underlying aetiology (16 vs. 4, p < 0.001) and a change in the management (10 vs. 3, p = 0.002). CONCLUSION Diagnostic workup in patients with MINOCA was limited to CAG in 61.8% of patients in this study. However, patients with advanced workup had a significantly higher association with the change in the treatment and identifying possible underlying aetiology in such patients.
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Affiliation(s)
| | | | - Shishir Soni
- Super-Specialty Hospital (SSH), NSCB Medical College, Jabalpur, MP, India.
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9
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Ferraù L, Giammello F, Tessitore A, Casella C, Iatì D, Ciacciarelli A, Tudisco V, Gardin A, Vinci SL, Musolino RF, La Spina P, Toscano A. Predictors of Good Functional Outcome in Patients with Tandem Occlusion After Revascularization Treatment: Single-Center Experience with 12-Month Follow-Up. World Neurosurg 2024; 188:e382-e389. [PMID: 38823443 DOI: 10.1016/j.wneu.2024.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE The optimal management and procedural strategy for tandem occlusion (TO) in acute ischemic stroke are still unclear, as is the long-term outcome of these patients. The aim of this study was to evaluate predictors of good functional outcome in patients with TO through the analysis of demographics, clinical, and radiological data with a 1-year follow-up. METHODS We collected data on 100 patients with TO who underwent revascularization treatments in our comprehensive stroke center. We divided patients into 2 groups: those with good functional outcome, defined as a modified Rankin Scale 0-2, and those with poor functional outcome, defined as a modified Rankin Scale 3-6 at 3, 6, and 12-month follow-up. Moreover, we investigated which variables were able to influence mortality. RESULTS At multivariate analysis, endovascular treatment with mechanical thrombectomy combined with emergent cervical carotid artery stenting was an independent predictor of good functional outcome at 6 and 12 months (adjusted odds ratio [aOR] 4.3, confidence interval [CI] 1.49-12.31, P = 0.007) (aOR 3.5, CI 1.25-9.61, P = 0.017) and was associated with a lower rate of mortality at 3 and 6 months follow-up (aOR 0.14, CI 0.04-0.57, P = 0.006 and aOR 0.296, CI 0.97-0.902, P = 0.032, respectively). Furthermore, smoking habit was associated with a better outcome at 3-month follow-up (aOR 10.7, CI 2.2-51.6, P = 0.003) but not at 6- and 12-month. CONCLUSIONS Our research, conducted in a small sample size of patients with acute ischemic stroke due to TO of anterior circulation, found that acute stent placement seems to be safe, improving clinical outcome, and it is associated with low rate of mortality at long-term follow-up.
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Affiliation(s)
- Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; Neurology and Stroke Unit, Neuchâtel Hospital Network (RHNe), Neuchâtel, Switzerland.
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Iatì
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy; Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Tudisco
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Gardin
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Hoang TH, Maiskov VV, Merai IA, Kobalava ZD. Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. KARDIOLOGIIA 2024; 64:56-63. [PMID: 39102574 DOI: 10.18087/cardio.2024.7.n2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2024]
Abstract
AIM To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA). MATERIAL AND METHODS This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years. RESULTS MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042). CONCLUSION The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.
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Affiliation(s)
- T H Hoang
- Pham Ngoc Thach University of Medicine; Tam Duc Cardiology Hospital
| | - V V Maiskov
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - I A Merai
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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11
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Kong M, Pei Z, Xie Y, Gao Y, Li J, He G. Prognostic factors of MINOCA and their possible mechanisms. Prev Med Rep 2024; 39:102643. [PMID: 38426041 PMCID: PMC10902145 DOI: 10.1016/j.pmedr.2024.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Despite not showing substantial stenosis of coronary arteries, Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) presents with myocardial ischemia injury, thus having a grave prognosis and a high risk of long-term complications. This necessitates increased clinical attention and exploration of its root causes to prevent a similar crisis. METHODS Research on MINOCA is limited, especially in terms of its clinical attributes, long-term outlook, risk stratification, and prognosis-linked cardiometabolic risk factors. This review aims to fill these gaps, providing an extensive overview of clinical trials and studies on MINOCA to separate the issue from the presence of non-obstructive coronary arteries in cardiac patients. RESULTS It has been found that MINOCA patients still face a high risk of long-term adverse events. Due to social and physiological factors, the hospital mortality rate is higher among women, and they are also more susceptible to MINOCA. Cardiac metabolic risk factors, including disorder of glucose and lipid metabolism, as well as changes in serum CysC levels, have significant impacts on the occurrence and prognosis of MINOCA. CONCLUSIONS Further research is still needed to fully understand the complex biological mechanisms underlying the prognostic factors of MINOCA. A profound understanding of these factors could reveal potential targets for improving prognosis, thereby indicating new strategies for managing this cardiovascular condition.
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Affiliation(s)
- Mowei Kong
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Zhenying Pei
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Yuyu Xie
- Department of Dermatology, Chengdu Fifth People’s Hospital, Chengdu, Sichuan 610000, PR China
| | - Yu Gao
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, PR China
| | - Jun Li
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Guoxiang He
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
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12
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La S, Beltrame J, Tavella R. Sex-specific and ethnicity-specific differences in MINOCA. Nat Rev Cardiol 2024; 21:192-202. [PMID: 37775559 DOI: 10.1038/s41569-023-00927-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Abstract
Suspected myocardial infarction with non-obstructive coronary arteries (MINOCA) has received increasing attention over the past decade. Given the heterogeneity in the mechanisms underlying acute myocardial infarction in the absence of obstructive coronary arteries, the syndrome of MINOCA is considered a working diagnosis that requires further investigation after diagnostic angiography studies have been performed, including coronary magnetic resonance angiography and functional angiography. Although once considered an infrequent and low-risk form of myocardial infarction, recent data have shown that the prognosis of MINOCA is not as benign as previously assumed. However, despite increasing awareness of the condition, many questions remain regarding the diagnosis, risk stratification and treatment of MINOCA. Women seem to be more susceptible to MINOCA, but studies on the sex-specific differences of the disease are scarce. Similarly, ethnicity-specific factors might explain discrepancies in the observed prevalence or underlying pathophysiological mechanisms of MINOCA but data are also scarce. Therefore, in this Review, we provide an update on the latest evidence available on the sex-specific and ethnicity-specific differences in the clinical features, pathophysiological mechanisms, treatment and prognosis of MINOCA.
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Affiliation(s)
- Sarena La
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - John Beltrame
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Rosanna Tavella
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia.
- Department of Cardiology, Central Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia.
- Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Selvanayagam JB, Pasupathy S. Challenging the Benign Perception: Unveiling the Prognostic Potential of CMR in MINOCA Patients. JACC Cardiovasc Imaging 2024; 17:162-164. [PMID: 37632502 DOI: 10.1016/j.jcmg.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Joseph B Selvanayagam
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Medical Centre, Adelaide, South Australia, Australia; South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Sivabaskari Pasupathy
- Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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14
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Lu X, Zhu S, Lu Y, Li Y. Long term all-cause mortality after myocardial infarction with non-obstructed vs obstructed coronary artery disease: a meta-analysis of adjusted data. BMC Cardiovasc Disord 2024; 24:9. [PMID: 38166759 PMCID: PMC10763149 DOI: 10.1186/s12872-023-03674-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The difference in the long-term outcomes of myocardial infarction in patients with non-obstructed coronary arteries (MINOCA) and patients with myocardial infarction with obstructed coronary artery disease (MI-CAD) is not clear. The current study aimed to pool adjusted data to compare long-term outcomes of MINOCA vs MI-CAD. METHODS Electronic literature search of PubMed, Embase, CENTRAL, and Google Scholar databases was done for publications up to 18th June 2023. Only studies reporting multivariable-adjusted data with > 1 year of follow-up were included. RESULTS Sixteen studies met the inclusion criteria. Our meta-analysis revealed no statistically significant difference in the risk of all-cause mortality between MINOCA and MI-CAD patients (HR: 0.90 95% CI 0.68, 1.19 I2 = 94% p = 0.48). Analysis of the limited data showed a reduced combined risk of all-cause mortality and MI (HR: 0.54 95% CI 0.39, 0.76 I2 = 72% p = 0.003) and major adverse cardiac events (MACE) (HR: 0.66 95% CI 0.51, 0.84 I2 = 51% p = 0.0009) in patients with MINOCA vs MI-CAD, and no difference in the risk of cardiovascular mortality (HR: 0.81 95% CI 0.54, 1.22 I2 = 0% p = 0.31) and readmission between the two groups (HR: 0.85 95% CI 0.61, 1.19 I2 = 90% p = 0.35). CONCLUSION A pooled analysis of adjusted outcomes from the available studies indicated that MINOCA and MI-CAD patients have similar long-term all-cause mortality risk. Our conclusions on the risk of cardiovascular mortality, MACE and readmission rates need to be taken with caution due to a lack of adequate studies. Further research is needed to strengthen the evidence on this important subject.
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Affiliation(s)
- Xueli Lu
- Cardiovascular Medicine, Huaihe Hospital of Henan University, Baogong Hubei Road, Kaifeng City, Henan Province, China.
| | - Shengnan Zhu
- Cardiovascular Medicine, Huaihe Hospital of Henan University, Baogong Hubei Road, Kaifeng City, Henan Province, China
| | - Yanjiao Lu
- Cardiovascular Medicine, Huaihe Hospital of Henan University, Baogong Hubei Road, Kaifeng City, Henan Province, China
| | - Yanming Li
- Cardiovascular Medicine, Huaihe Hospital of Henan University, Baogong Hubei Road, Kaifeng City, Henan Province, China
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15
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Mohammed AQ, Abdu FA, Liu L, Yin G, Mareai RM, Mohammed AA, Xu Y, Che W. Coronary microvascular dysfunction and myocardial infarction with non-obstructive coronary arteries: Where do we stand? Eur J Intern Med 2023; 117:8-20. [PMID: 37482469 DOI: 10.1016/j.ejim.2023.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/15/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
In the past decade, scientific and clinical research has provided a translational perspective on myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is characterized by clinical documentation of an acute MI but angiography shows no significant coronary artery obstruction (stenosis <50%). The prevalence of MINOCA is estimated to range from approximately 6 to 10% among MI patients, and those with this condition have a poor prognosis, experiencing high rates of mortality, rehospitalization, and socioeconomic burden. MINOCA represents a major unmet need in cardiovascular medicine, with uncertain clinical management. It is a complex condition that can be caused by various factors, including atherosclerosis, plaque rupture, coronary vasospasm, and microvascular dysfunction. Effective management of MINOCA depends on identifying the underlying mechanism of the infarction, thus a systematic diagnostic approach is recommended. Contemporary data shows that a significant number of patients exhibit structural and functional abnormalities in coronary microcirculation, which is referred to as coronary microvascular dysfunction (CMD). CMD plays a crucial role in patients with signs and symptoms of myocardial ischemia and non-obstructive coronary artery stenosis, including MINOCA. Furthermore, conducting a thorough evaluation of coronary function can have significant prognostic and therapeutic implications, since personalized patient management strategies based on this assessment have been shown to improve symptoms and prognosis. Therefore, an accurate and timely diagnosis of CMD is essential for effective patient management, which can be achieved through various invasive and non-invasive methods. This review will discuss the pathophysiological understanding, current diagnostic techniques, and management strategies of patients with MINOCA and CMD.
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Affiliation(s)
- Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China.
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16
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Samaras A, Moysidis DV, Papazoglou AS, Rampidis G, Kampaktsis PN, Kouskouras K, Efthymiadis G, Ziakas A, Fragakis N, Vassilikos V, Giannakoulas G. Diagnostic Puzzles and Cause-Targeted Treatment Strategies in Myocardial Infarction with Non-Obstructive Coronary Arteries: An Updated Review. J Clin Med 2023; 12:6198. [PMID: 37834842 PMCID: PMC10573806 DOI: 10.3390/jcm12196198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a distinct subtype of myocardial infarction (MI), occurring in about 8-10% of spontaneous MI cases referred for coronary angiography. Unlike MI with obstructive coronary artery disease, MINOCA's pathogenesis is more intricate and heterogeneous, involving mechanisms such as coronary thromboembolism, coronary vasospasm, microvascular dysfunction, dissection, or plaque rupture. Diagnosing MINOCA presents challenges and includes invasive and non-invasive strategies aiming to differentiate it from alternative diagnoses and confirm the criteria of elevated cardiac biomarkers, non-obstructive coronary arteries, and the absence of alternate explanations for the acute presentation. Tailored management strategies for MINOCA hinge on identifying the underlying cause of the infarction, necessitating systematic diagnostic approaches. Furthermore, determining the optimal post-MINOCA medication regimen remains uncertain. This review aims to comprehensively address the current state of knowledge, encompassing diagnostic and therapeutic approaches, in the context of MINOCA while also highlighting the evolving landscape and future directions for advancing our understanding and management of this intricate myocardial infarction subtype.
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Affiliation(s)
- Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Andreas S. Papazoglou
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Georgios Rampidis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Polydoros N. Kampaktsis
- Department of Medicine, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY 10032, USA;
| | - Konstantinos Kouskouras
- Department of Radiology, AHEPA University General Hospital of Thessaloniki, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Georgios Efthymiadis
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
| | - Nikolaos Fragakis
- Second Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - Vasileios Vassilikos
- Third Cardiology Department, Hippokration General Hospital of Thessaloniki, 546 42 Thessaloniki, Greece;
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 546 36 Thessaloniki, Greece; (A.S.); (D.V.M.); (A.S.P.); (G.R.); (G.E.); (A.Z.)
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Fedele D, Canton L, Bodega F, Suma N, Tattilo FP, Impellizzeri A, Amicone S, Di Iuorio O, Ryabenko K, Armillotta M, Sansonetti A, Stefanizzi A, Cavallo D, Casuso M, Bertolini D, Lovato L, Gallinoro E, Belmonte M, Rinaldi A, Angeli F, Casella G, Foà A, Bergamaschi L, Paolisso P, Pizzi C. Performance of Prognostic Scoring Systems in MINOCA: A Comparison among GRACE, TIMI, HEART, and ACEF Scores. J Clin Med 2023; 12:5687. [PMID: 37685754 PMCID: PMC10488766 DOI: 10.3390/jcm12175687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Background: the prognosis of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not benign; thus, prompting the need to validate prognostic scoring systems for this population. Aim: to evaluate and compare the prognostic performance of GRACE, TIMI, HEART, and ACEF scores in MINOCA patients. Methods: A total of 250 MINOCA patients from January 2017 to September 2021 were included. For each patient, the four scores at admission were retrospectively calculated. The primary outcome was a composite of all-cause death and acute myocardial infarction (AMI) at 1-year follow-up. The ability to predict 1-year all-cause death was also tested. Results: Overall, the tested scores presented a sub-optimal performance in predicting the composite major adverse event in MINOCA patients, showing an AUC ranging between 0.7 and 0.8. Among them, the GRACE score appeared to be the best in predicting all-cause death, reaching high specificity with low sensitivity. The best cut-off identified for the GRACE score was 171, higher compared to the cut-off of 140 generally applied to identify high-risk patients with obstructive AMI. When the scores were tested for prediction of 1-year all-cause death, the GRACE and the ACEF score showed very good accuracy (AUC = 0.932 and 0.828, respectively). Conclusion: the prognostic scoring tools, validated in AMI cohorts, could be useful even in MINOCA patients, although their performance appeared sub-optimal, prompting the need for risk assessment tools specific to MINOCA patients.
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Affiliation(s)
- Damiano Fedele
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Francesco Pio Tattilo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Ornella Di Iuorio
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Andrea Stefanizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Daniele Cavallo
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Davide Bertolini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Luigi Lovato
- Pediatric and Adult CardioThoracic and Vascular, Onchoematologic, and Emergency Radiology Unit, IRCSS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
| | - Emanuele Gallinoro
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
| | - Marta Belmonte
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy;
- Cardiovascular Center Aalst, OLV Hospital, 9300 Aalst, Belgium
| | - Andrea Rinaldi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Gianni Casella
- Unit of Cardiology, Maggiore Hospital, 40131 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Clinical Cardiology and Cardiovascular Imaging Unit, Galeazzi-Sant’Ambrogio Hospital, IRCCS, 20157 Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy;
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy (L.B.)
- Department of Medical and Surgical Sciences—DIMEC, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
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Naeem MO, Khan SK, Gergess RR, Addi Palle LR, Krupanagaram S, Khan MW, Haseeb MD, Hirani S. Comparison of Long-Term Outcomes of Patients With Myocardia Infarction (MI) With Non-obstructive Coronary Arteries and MI With Obstructive Coronary Arteries: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43137. [PMID: 37692745 PMCID: PMC10484151 DOI: 10.7759/cureus.43137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
The aim of this study was to compare long-term outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and patients with myocardial infarction with obstructive coronary arteries (MIOCA). This meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search was conducted in online databases including PubMed and Web of Science from 2010 onwards. Primary outcomes assessed in this meta-analysis included major adverse cardiovascular events (MACE) and all-cause mortality. Secondary outcomes included cardiovascular mortality and myocardial infarction. A total of 16 studies were included in the meta-analysis. Pooled analysis showed that the risk of MACE was higher in MIOCA patients (risk ratio (RR): 1.47, 95%CI: 1.43-1.52, p-value: 0.001) compared to MINOCA patients. Additionally, the risk of all-cause mortality was also significantly higher in MIOCA patients compared to MINOCA (RR: 1.33, 95%CI: 1.14-1.56, p-value: 0.001). Our findings also indicate that patients with MIOCA are at a significantly higher risk of recurrent myocardial infarction and cardiovascular-related mortality compared to patients with MINOCA. Overall, the insights gained from this meta-analysis have significant clinical implications, guiding decision-making in the management of patients with MINOCA.
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Affiliation(s)
| | | | - Ramy R Gergess
- Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, MEX
| | - Lokeshwar Raaju Addi Palle
- Surgery, Kamala Hospital, Chennai, IND
- General Surgery, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
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19
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Jia F, Fei SF, Tong DB, Zhang S, Li JJ. Do Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries Have Similar Prognosis Compared to Ones with MI-CAD? Angiology 2023; 74:407-416. [PMID: 35993693 DOI: 10.1177/00033197221121191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide and it is primarily caused by acute plaque disruption and coronary occlusion. Recent studies suggest that myocardial infarction with non-obstructive coronary arteries (MINOCA) also occurs but the underlying mechanisms have not been fully understood until recently. The evidence also suggests that the clinical outcomes of patients presenting with MINOCA are similar to AMI patients with obstructive coronary artery disease (MI-CAD), including all-cause mortality and major adverse cardiovascular events. The present narrative review considers the risk factors, pathological changes, and outcomes associated with MINOCA and compares them with MI-CAD.
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Affiliation(s)
- Fang Jia
- Department of Cardiology, 117850The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Si-Fan Fei
- Department of Cardiology, 117850The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - De-Bing Tong
- Department of Cardiology, 117850The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Sheng Zhang
- Department of Cardiology, 117850The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jian-Jun Li
- Cardio-Metabolic Center, 569172Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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20
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Borzillo I, De Filippo O, Manai R, Bruno F, Ravetti E, Galanti AA, Vergallo R, Porto I, De Ferrari GM, D’Ascenzo F. Role of Intracoronary Imaging in Myocardial Infarction with Non-Obstructive Coronary Disease (MINOCA): A Review. J Clin Med 2023; 12:2129. [PMID: 36983131 PMCID: PMC10051698 DOI: 10.3390/jcm12062129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/30/2023] Open
Abstract
Myocardial infarction with non-obstructive coronary artery disease occurs in 6% to 15% of all presentation of myocardial infarctions. The pathophysiologic mechanisms of MINOCA include epicardial vasospasm, coronary microvascular disorder, spontaneous coronary artery dissection, and coronary thrombus/embolism. The diagnosis is challenging, supported by intracoronary imaging with intravascular ultrasound (IVUS) and optical coherent tomography (OCT), coronary physiology testing, and cardiac magnetic resonance imaging (CMR). OCT is able to identify atherosclerotic causes of MINOCA (plaque erosion, plaque rupture, and calcified nodule) and nonatherosclerotic causes (spontaneous artery dissection, and spasm). In this review, we summarize the performance of the two intracoronary imaging modalities (IVUS and OCT) in MINOCA and discuss the importance of supplementing these modalities with CMR in order to drive target therapy.
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Affiliation(s)
- Irene Borzillo
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Rossella Manai
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Alma Andrea Galanti
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Rocco Vergallo
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine, University of Genoa, 16132 Genoa, Italy
- Cardiology Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, “Città della Salute e della Scienza” Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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21
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Demirelli S, Md KAT, Taşolar H, Çalapkorur B, Ergün G, Demirci E. Assessment of a New Electrocardiographic Marker for the Diagnosis of Myocardial Infarction With Non-obstructive Coronary Arteries. Angiology 2023; 74:288-295. [PMID: 35451331 DOI: 10.1177/00033197221089373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is clinically defined as myocardial infarction in the absence of obstructive atherosclerosis on coronary angiography. Diagnosis may require multiple diagnostic tools in addition to standard coronary angiography, including cardiac imaging or provocative tests, according to clinical suspicion. We assessed the usefulness of the DETERMINE (Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation) score for distinguishing patients with MINOCA from those with non-ST segment elevation myocardial infarction with obstructive coronary artery disease (NSTEMI-CAD) in a single-center observational study. The patients were divided into two groups according to coronary angiography findings. The study included 277 patients: 227 with NSTEMI-CAD and 50 with MINOCA. The DETERMINE score (6.1 ± 3.7 vs 1.9 ± 2.1, P<.001) was significantly higher in the NSTEMI-CAD than MINOCA group. Logistic regression analysis revealed that the DETERMINE score (OR=0.591, P<0.001) was an independent predictor of MINOCA. The incidence of diabetes mellitus and glucose levels were significantly higher in the NSTEMI-CAD group; however, ejection fraction was significantly higher in the MINOCA group (P<0.05). Our findings suggest that the DETERMINE score constitutes a simple and inexpensive tool for the assessment of MINOCA.
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Affiliation(s)
- Selami Demirelli
- Department of Cardiology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Kemal Abid Tekin Md
- Department of Cardiology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Hakan Taşolar
- Department of Cardiology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Bekir Çalapkorur
- Department of Cardiology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Gökhan Ergün
- Department of Cardiology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Demirci
- Department of Cardiology, University of Health Sciences, Kayseri City Hospital, Kayseri, Turkey
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22
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Chen L, Fan Y, Fang Z, Liu N. Long-term outcomes and predictors of patients with ST elevated versus non-ST elevated myocardial infarctions in non-obstructive coronary arteries: a retrospective study in Northern China. PeerJ 2023; 11:e14958. [PMID: 36890872 PMCID: PMC9987296 DOI: 10.7717/peerj.14958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous disease entity with diverse etiologies and no uniform treatment protocols. Patients with MINOCA can be clinically classified into two groups based on whether they have an ST-segment elevation (STE) or non-ST segment elevation (NSTE), based on electrocardiogram (ECG) results, whose clinical prognosis is unclear. This study aimed to compare the outcomes and predictors of patients with STE and NSTE in the MINOCA population. Methods We collected the data for 196 patients with MINOCA (115 with STE and 81 with NSTE) in China. Clinical characteristics, prognoses, and predictors of major adverse cardiovascular events (MACE) were analyzed during the follow-up of all patients. Results The proportion of patients with STE was greater than that with NSTE in the MINOCA population. Patients with NSTE were older and had a higher incidence of hypertension. No differences were observed in the outcomes between the STE and NSTE groups during a median follow-up period of 49 (37,46) months. No significant differences were observed in those with MACE (24.35% vs 22.22%, P = 0.73) and those without MACE. The multivariable predictors of MACE in the NSTE groups were Killip grades ≥ 2 (HR 9.035, CI 95% [1.657-49.263], P = 0.011), reduced use of β-blockers during hospitalization (HR 0.238, CI 95% [0.072-0.788], P = 0.019), and higher levels of low-density lipoprotein cholesterol (LDL-C) (HR 2.267, CI 95% [1.008-5.097], P = 0.048); the reduced use of β-blockers during hospitalization was the only independent risk factor of MACE in the STE group. Conclusions There were differences between the clinical characteristics of patients with STE and NSTE in the MINOCA population, even though outcomes during follow-up were similar. Independent risk factors for major adverse cardiac events were not identical in the STE and NSTE groups, which could be attributable to the differences in disease pathogenesis.
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Affiliation(s)
- Lin Chen
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China.,Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yinghong Fan
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China.,Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhen Fang
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| | - Ning Liu
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
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23
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Tasbulak O, Duran M, Kahraman S, Can C, Demirci G, Ulutas AE, Cizgici AY, Kalkan AK, Celik O, Yalcin AA, Erturk M. Role of triglyceride glucose index in long-term mortality of patients with lower extremity arterial disease. Biomark Med 2022; 16:1219-1228. [PMID: 36790174 DOI: 10.2217/bmm-2022-0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Aim: This work was designed to explore the role of the triglyceride-glucose (TyG) index in the prediction of long-term mortality in patients with lower extremity artery disease (LEAD) undergoing endovascular revascularization. Methods: The records of 723 patients with symptomatic LEAD undergoing endovascular revascularization between January 2016 and December 2021, with long-term follow-up until December 2021, were analyzed. Results: The rate of long-term mortality was significantly higher among patients with high TyG index than patients with low TyG index. Conclusion: The TyG index is an independent predictor of long-term mortality in patients with LEAD undergoing endovascular revascularization.
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Affiliation(s)
- Omer Tasbulak
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Mustafa Duran
- Department of Cardiology, Konya City Hospital, Akabe, Adana Çevre Yolu Cd. No:135/1, Karatay, Konya, 42020, Turkey
| | - Serkan Kahraman
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Cemil Can
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Gokhan Demirci
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Ahmet E Ulutas
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Ahmet Y Cizgici
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Ali K Kalkan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Omer Celik
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Ahmet A Yalcin
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
| | - Mehmet Erturk
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic & Cardiovascular Surgery Training & Research Hospital, Halkalı Merkez, Küçükçekmece, Istanbul, 34303, Turkey
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24
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Anterior wall STEMI in a patient with paroxysmal atrial fibrillation due to coronary embolism: A case report. Ann Med Surg (Lond) 2022; 82:104602. [PMID: 36268397 PMCID: PMC9577526 DOI: 10.1016/j.amsu.2022.104602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Coronary embolism (CE) is a rare cause of acute ST-elevation myocardial infarction (STEMI). Atrial fibrillation (AF), left ventricular thrombus, septic emboli from infective endocarditis, myxoma, and paradoxical embolism can induce emboli in coronary arteries. Case presentation Here we present a case of anterior wall STEMI secondary to paroxysmal AF in a 60-years-old female with a previous history of right-sided ischemic stroke. Discussion The major criteria for diagnosis of coronary embolism include (1) non-atherosclerotic wall of coronary vessels under angiography; (2) concomitant involvement of multiple sites; (3) histological proof of venous thrombus; (4) imaging by echocardiography/CT/MRI showing intra-cardiac thrombus. The minor criteria include (1) <25% stenosis of other vessels supplying to infarct-free myocardium; (2) atrial fibrillation history; (3) risk factors like (prosthetic valve, bacterial endocarditis, patent foramen ovale, atrial septal defect, dilated cardiomyopathy). Conclusion Our case highlights the importance of cardiac embolus as a diagnosis in a patient with a history of stroke secondary to atrial fibrillation as a cause of acute STEMI and its management.
Cardioembolism is an underappreciated etiology of the acute coronary syndrome in the patient with atrial fibrillation. Cardiac embolus may be in a patient with the history of stroke secondary to atrial fibrillation as a cause of acute STEMI.
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One-Year Prospective Follow-up of Women With INOCA and MINOCA at a Canadian Women’s Heart Centre. Can J Cardiol 2022; 38:1600-1610. [DOI: 10.1016/j.cjca.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022] Open
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Gao S, Xu H, Ma W, Yuan J, Yu M. Remnant Cholesterol Predicts Risk of Cardiovascular Events in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. J Am Heart Assoc 2022; 11:e024366. [PMID: 35535621 PMCID: PMC9238562 DOI: 10.1161/jaha.121.024366] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
Background Remnant cholesterol (RC) has been reported to promote atherosclerotic cardiovascular disease. Yet little is known regarding the RC-related residual risk in patients with myocardial infarction (MI) with nonobstructive coronary arteries. Methods and Results A total of 1179 patients with MI with nonobstructive coronary arteries were enrolled and divided according to median level of RC calculated as non-high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. The primary end point was a composite of major adverse cardiovascular events (MACEs), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were used. Patients with higher median level of RC had a significantly higher incidence of MACEs (16.9% versus 11.5%; P=0.009) over the median follow-up of 41.7 months. High RC levels were significantly associated with an increased risk of MACEs after adjustment for multiple clinically relevant variables (per 1 SD increase, hazard ratio, 0.61; 95% CI, 1.12-2.31; P=0.009). Elevated RC also contributed to residual risk beyond conventional lipid parameters. Moreover, RC had an area under the curve of 0.61 for MACE prediction. When adding RC to the Thrombolysis in Myocardial Infarction risk score, the combined model yielded a significant improvement in discrimination for MACEs. Conclusions Elevated RC was closely associated with poor outcomes after MI with nonobstructive coronary arteries independent of traditional risk factors, indicating the utility of RC for risk stratification and a rationale for targeted RC-lowering trials in patients with MI with nonobstructive coronary arteries.
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Affiliation(s)
- Side Gao
- Department of CardiologyBeijing Chaoyang HospitalCapital Medical UniversityBeijingChina
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Haobo Xu
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenjian Ma
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiansong Yuan
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Khan A, Lahmar A, Riasat M, Ehtesham M, Asif H, Khan W, Haseeb M, Boricha H. Myocardial Infarction With Non-obstructive Coronary Arteries: An Updated Overview of Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e23602. [PMID: 35505697 PMCID: PMC9053360 DOI: 10.7759/cureus.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) refers to acute myocardial infarction with normal or near-normal coronary arteries. The MINOCA is a heterogeneous group of conditions, and possible etiologies are coronary artery spasm, spontaneous coronary artery dissection, coronary thromboembolism, coronary plaque disruption, coronary microvascular dysfunction, supply and demand mismatch. It is more common in young adults, with women having a higher chance of getting MINOCA than men. Considering MINOCA as a clinically dynamic working diagnostic that needs further investigation rather than a “true” diagnosis is proposed. Optical coherence tomography (OCT), intravenous ultrasound (IVUS), cardiac MRI may be required to stratify the underlying mechanism. Due to the lack of evidence-based literature and prospective randomized controlled studies, therapeutic management is limited. Consequently, the strategy is patient-specific. The prognosis of MINOCA patients remains unclear and depends upon the underlying etiology. This article aims to review the literature about various aspects of MINOCA, including pathophysiology, diagnosis, prognosis, and treatment.
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Lopez-Pais J, Izquierdo Coronel B, Raposeiras-Roubín S, Álvarez Rodriguez L, Vedia O, Almendro-Delia M, Sionis A, Martin-Garcia AC, Uribarri A, Blanco E, Martín de Miguel I, Abu-Assi E, Galán Gil D, Sestayo Fernández M, Espinosa Pascual MJ, Agra-Bermejo RM, López Otero D, García Acuña JM, Alonso Martín JJ, Gonzalez-Juanatey JR, Perez de Juan Romero MÁ, Núñez-Gil IJ. Differences Between Takotsubo and the Working Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries. Front Cardiovasc Med 2022; 9:742010. [PMID: 35360039 PMCID: PMC8964136 DOI: 10.3389/fcvm.2022.742010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/20/2022] [Indexed: 01/30/2023] Open
Abstract
Aim Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCAs. Methods and Results A cohort study based on two prospective registries: TTS from the RETAKO registry (N:1,015) and patients with non-TTS MINOCAs from contemporary records of acute myocardial infarction from five 5 national centers (N:1,080). Definitions and management recommended by the ESC were used. Survival analysis was based on the Cox regression analysis; propensity score matching (PS) was created to adjust prognostic variables. Takotsubo syndrome were more often women (85.9 vs. 51.9%; p < 0.001) and older (69.4 ± 12.5 vs. 64.5 ± 14.1 years; p < 0.001). Atrial fibrillation (AF) was more frequent in non-TTS MINOCAs (10.4 vs. 14.4%; p = 0.007). Psychiatric disorders were more prevalent in TTS (15.5 vs. 10.2%, p < 0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs. 1.8%, (p = 0.015), and 25.8 vs. 11.5%, (p < 0.001). Global mortality before PS matching was 16.1% in non-TTS MINOCAs and 8.1% in TTS. Median follow-up was 32.4 months; after PS matching, TTS had fewer major adverse cardiovascular events (MACEs): hazard ratio (HR) 0.59; 95% CI 0.42-0.83. There were no differences in global mortality (HR 0.87; CI: 0.64-1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35-0.98). Conclusion Compared to the rest of MINOCAs, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.
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Affiliation(s)
- Javier Lopez-Pais
- Cardiology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | | | - Leyre Álvarez Rodriguez
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Oscar Vedia
- Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Aitor Uribarri
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Emilia Blanco
- Cardiology Department, Hospital Arnau de Vilanova, Lérida, Spain
| | | | - Emad Abu-Assi
- Cardiology Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - David Galán Gil
- Cardiology Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Manuela Sestayo Fernández
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Rosa María Agra-Bermejo
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Diego López Otero
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose María García Acuña
- Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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Abdu FA, Mohammed AQ, Liu L, Yin G, Xu S, Mohammed AA, Mareai RM, Xu Y, Che W. Metabolic syndrome and the risk of adverse cardiovascular events in patients with myocardial infarction with non-obstructive coronary arteries. Nutr Metab Cardiovasc Dis 2022; 32:666-674. [PMID: 35140026 DOI: 10.1016/j.numecd.2022.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MeS) is recognized as a significant predictor of poor outcomes in coronary artery disease. However, its prognostic implications in myocardial infarction with non-obstructive coronary arteries (MINOCA) have not been examined. We aimed at investigating the role of MeS on the clinical outcomes in MINOCA patients. METHODS AND RESULTS Patients diagnosed with MINOCA between 2015 and 2019 were included. MeS was defined according to modified NCEP-ATPIII criteria. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression analysis was used to evaluate the correlation between MeS and the hazard of MACE. The integrated discrimination improvement (IDI) and net reclassification index (NRI) were performed to assess MeS incremental predictive value. Of 281 MINOCA patients, 83 (29.5%) patients satisfied the MeS criteria. During a median follow-up duration of 28 months, MINOCA patients with MeS had a notably higher rate of MACE than those without MeS (30.1% vs. 17.6%, respectively P = 0.020). Cox regression analysis revealed that MeS was associated with an increased hazard of MACE (adjusted HR 2.126; 95% CI: 1.193-3.787, P = 0.010). When each component of MeS was analyzed as a categorized variable separately, only high fasting blood glucose and BMI ≥25 kg/m2 were associated with an increased hazard of MACE. Moreover, MeS had an incremental predictive ability for MACE when added to a model with clinical risk factors. CONCLUSION MeS is relatively common in patients with MINOCA. The presence of MeS significantly increased the hazard of MACE among the MINOCA population.
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Affiliation(s)
- Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ayman A Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Redhwan M Mareai
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China.
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Li M, He Y, Cheang I, Zhang Z, Liu Y, Wang H, Kong X. Clinical characteristics and outcome in patients with ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery: an observation study from Chinese population. BMC Cardiovasc Disord 2022; 22:21. [PMID: 35090391 PMCID: PMC8800222 DOI: 10.1186/s12872-021-02359-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background The disparity between ST-segment and non-ST-segment elevation myocardial infarction without obstructive coronary artery (STE-MINOCA and NSTE-MINOCA) are unclear. Our study aims to compare the clinical features and outcomes in patients with STE-MINOCA and NSTE-MINOCA. Methods This cross-sectional study consecutively enrolled patients diagnosed with acute myocardial infarction (AMI) from January 2013 to January 2020. MINOCA were identified as angiographic stenosis < 50%. Clinical characteristics, angiographic features, and clinical outcomes of STE-MINOCA and NSTE-MINCOA were documented. The primary endpoint was composite events in the different time periods. Results A total of 1966 AMI patients were screened, 107 (5.4%) were diagnosed as MINOCA. Among, there were 34 (31.8%) of STE-MINOCA and 73 (68.2%) of NSTE-MINOCA. STE-MINOCA group were younger, had lower N-terminal pro-brain natriuretic peptide (NT-proBNP), and smaller left atrial diameter (P < 0.05). Dual antiplatelet therapy (DAPT) was more likely to be prescribed to STE-MINOCA patients (P = 0.015). During median follow-up time of 24.5 months, STE-MINOCA group also demonstrated lower risks for primary endpoint and cardiovascular-related (CVS) rehospitalization. In univariate Cox regression analyses, NSTE-MINOCA showed an increased risk of long-term primary endpoint (HR 2.57, 95 CI%: 1.10–6.02) and CVS-related rehospitalization (HR 3.14, 95% CI: 1.16–8.48). After adjusting for NT-proBNP and DAPT, NSTE-MINOCA remained an independent risk factor for CVS-related rehospitalization in long-term follow-up (HR 2.78, 95% CI: 1.03–7.49). Conclusion Although STE-MINOCA and NSTE-MINOCA patients showed similar clinical characteristics, NSTE-MINOCA group presented a worse long-term outcome mainly driven by CVS-related hospitalization which suggested that NSTE-MINOCA patients might also require prompt medical attention.
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Randomized Pilot Trial on Optimal Treatment Strategy, Myocardial Changes, and Prognosis of Patients with Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA). Am J Med 2022; 135:103-109. [PMID: 34562410 DOI: 10.1016/j.amjmed.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) remains an unresolved challenge. Many different diagnostic approaches are often required to diagnose, confirm, and evaluate MINOCA. The prevalence can be as high as 13% of all acute myocardial infarction patients, indicating that this condition is not rare. At this time, there have been no completed randomized clinical trials involving MINOCA patients, and a better understanding of the mechanisms and management of these patients is important. This exploratory analysis seeks to find possible etiologic factors, the value of novel biomarkers, and the effect of different treatment strategies in patients with MINOCA. METHODS This prospective randomized pilot trial will include 150 patients with MINOCA. A thorough clinical, laboratory, and imaging evaluation will be performed, including novel biomarkers and modern imaging techniques (heart magnetic resonance imaging and noninvasive testing). The duration of the enrollment is 18 months, and duration of the follow-up is 12 months from the enrollment of the first patient. RESULTS The trial is registered under www.clinicaltrials.gov: NCT04538924. The study is currently recruiting participants. CONCLUSIONS Because MINOCA is not a benign disease, the results of the current investigation could inform future diagnostic and therapeutic strategies and enhance the understanding of MINOCA patients.
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Ma W, Gao S, Huang S, Yuan J, Yu M. Hyperuricemia as a prognostic marker for long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Nutr Metab (Lond) 2021; 18:107. [PMID: 34930343 PMCID: PMC8686602 DOI: 10.1186/s12986-021-00636-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022] Open
Abstract
Background Hyperuricemia (HUA) has been proved as a predictor of worse outcomes in patients with coronary artery disease. Here, we investigated the prognostic value of HUA in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA). Methods A total of 1179 MINOCA patients were enrolled and divided into HUA and non-HUA groups. HUA was defined as a serum uric acid level ≥ 420 μmol/L in men or ≥ 357 μmol/L in women. The primary study endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier, Cox regression, and receiver-operating characteristic analyses were performed. Results Patients with HUA (prevalence of 23.5%) had a significantly higher incidence of MACE (18.7% vs. 12.8%; p = 0.015) than patients without during the median follow-up of 41.7 months. HUA was closely associated with an increased risk of MACE even after multivariable adjustment (hazard ratio 1.498, 95% confidence interval: 1.080 to 2.077; p = 0.016). HUA remained a robust risk factor of MACE after propensity score matching analysis. Moreover, HUA showed an area under the curve (AUC) of 0.59 for predicting MACE. Incorporation of HUA to the thrombolysis in myocardial infarction (TIMI) score yielded a significant improvement in discrimination for MACE. Conclusions HUA was independently associated with poor prognosis after MINOCA. Routine assessment of HUA may facilitate risk stratification in this specific population. Supplementary Information The online version contains supplementary material available at 10.1186/s12986-021-00636-2.
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Affiliation(s)
- Wenjian Ma
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Side Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Sizhuang Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China.
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China.
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Gao S, Ma W, Huang S, Lin X, Yu M. Impact of low triiodothyronine syndrome on long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Ann Med 2021; 53:741-749. [PMID: 34037508 PMCID: PMC8158241 DOI: 10.1080/07853890.2021.1931428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low triiodothyronine syndrome (LT3S), frequently seen in patients with acute myocardial infarction (AMI), has been regarded as a predictor of poor outcomes after AMI. However, little is known about the prognostic value of LT3S in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). METHODS A total of 1162 MINOCA patients were enrolled and divided into LT3S and no-LT3S groups. LT3S was defined as decreased free T3 (fT3 < 2.36 pg/mL) with normal values of thyroid-stimulating hormone. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, propensity score matching (PSM), and receiver-operating characteristic analyses were performed. RESULTS Patients with LT3S (prevalence of 17.5%) had a significantly higher incidence of MACE (19.6% vs. 12.9%; p = .013) than patients without during the median follow-up of 41.7 months. LT3S was closely associated with an increased risk of MACE even after multivariable adjustment (HR 1.50, 95% CI: 1.03-2.18, p = .037). After PSM, 197 pairs of patients with or without LT3S were identified, and LT3S remained a robust risk factor of worse outcomes (HR 1.53, 95% CI: 1.02-2.65, p = .042). Moreover, LT3S had an area under the curve (AUC) of 0.60 for predicting MACE. When adding LT3S to the thrombolysis in myocardial infarction (TIMI) risk score, the combined model yielded a significant improvement in discrimination for MACE. CONCLUSIONS LT3S was independently associated with poor outcomes after MINOCA. Routine assessment of LT3S may provide valuable prognostic information in this specific population.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjian Ma
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sizhuang Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuze Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Gao S, Ma W, Huang S, Lin X, Yu M. Impact of triglyceride-glucose index on long-term cardiovascular outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Nutr Metab Cardiovasc Dis 2021; 31:3184-3192. [PMID: 34511291 DOI: 10.1016/j.numecd.2021.07.027] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/05/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Triglyceride-glucose (TyG) index has been reported as a novel surrogate marker of insulin resistance and a risk factor in patients with coronary artery disease. We aimed to investigate the prognostic value of TyG index in a distinct entity with myocardial infarction with nonobstructive coronary arteries (MINOCA). METHODS AND RESULTS A total of 1179 MINOCA patients were recruited and divided according to tertile levels of TyG index. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, reinfarction, stroke, revascularization and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression and receiver-operating characteristic analyses were performed. Patients with higher tertiles of TyG index had a significantly higher incidence of MACE (9.6%, 14.9%, 18.0%; p = 0.003) over the median follow-up of 41.7 months. After multivariate adjustment, elevated TyG index was significantly associated with an increased risk of MACE (HR 1.33, 95% CI: 1.04-1.69, p = 0.020). The adjusted risk of MACE also increased with rising tertiles of TyG index (tertile 1 as reference; tertile 2: HR 1.64, 95% CI: 1.06-2.53, p = 0.025; tertile 3: HR 1.85, 95% CI: 1.17-2.93, p = 0.008). The TyG index remained a robust risk factor in overall and subgroups of MINOCA patients (all p < 0.05). Moreover, the TyG index yielded a moderate predictive value of MACE (area under the curve 0.66, 95% CI:0.61-0.71, p < 0.001). CONCLUSION Elevated TyG index was independently associated with a poor prognosis after MINOCA. Routine assessment of TyG index may improve risk stratification and facilitate decision making in MINOCA patients.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjian Ma
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sizhuang Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuze Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Pasupathy S, Lindahl B, Tavella R, Nordenskjöld AM, Zeitz C, Arstall M, Worthley M, Neil C, Singh K, Turner S, Rajwani A, Mooney J, Beltrame JF. Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment for Post Infarct Angina in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries: A MINOCA-BAT Sub Study Rationale and Design. Front Cardiovasc Med 2021; 8:717526. [PMID: 34692780 PMCID: PMC8531437 DOI: 10.3389/fcvm.2021.717526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in ~10% of all patients with acute myocardial infarction (AMI), with an over-representation amongst women. Remarkably, it is estimated that as many as 1 in 4 patients with MINOCA experience ongoing angina at 12 months despite having no flow-restricting stenoses in their epicardial arteries. This manuscript presents the rationale behind Randomized Evaluation of Beta Blocker and Angiotensin-converting enzyme inhibitors/Angiotensin Receptor Blocker Treatment (ACEI/ARB) for Post Infarct Angina in MINOCA patients-The MINOCA BAT post infarct angina sub study. Methods: This trial is a registry-based, randomized, parallel, open-label, multicenter trial with 2 × 2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce post infarct angina in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 664 patients will be randomized into four groups; (i) ACEI/ARB with beta blocker, (ii) beta blocker only, (iii) ACEI/ARB only, or (iv) neither ACEI/ARB nor beta blocker and followed for 12 months. Results: The trial is currently recruiting in Australia and Sweden. Fifty six patients have been recruited thus far. Both sexes were equally distributed (52% women and 48% men) and the mean age was 56.3 ± 9.9 years. Conclusions: It remains unclear whether conventional secondary preventive therapies are beneficial to MINOCA patients in regard to post infarct angina. Existing registry-based literature suggest cardioprotective agents are less likely to be used in MINOCA patients. Thus, results from this trial will provide insights for future treatment strategies and guidelines specific to MINOCA patients.
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Affiliation(s)
- Sivabaskari Pasupathy
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia.,Basil Hetzel Institute, Adelaide, SA, Australia
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Rosanna Tavella
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia.,Basil Hetzel Institute, Adelaide, SA, Australia
| | - Anna M Nordenskjöld
- Department of Cardiology, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christopher Zeitz
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia.,Basil Hetzel Institute, Adelaide, SA, Australia
| | - Margaret Arstall
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Matthew Worthley
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Christopher Neil
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Kuljit Singh
- Department of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Stuart Turner
- Department of Cardiology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Adil Rajwani
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - John Mooney
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia
| | - John F Beltrame
- Faculty of Health Sciences, The University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Central Adelaide Local Health Network, Adelaide, SA, Australia.,Basil Hetzel Institute, Adelaide, SA, Australia
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Gao S, Ma W, Huang S, Lin X, Yu M. Impact of prediabetes on long-term cardiovascular outcomes in patients with myocardial infarction with nonobstructive coronary arteries. Diabetol Metab Syndr 2021; 13:103. [PMID: 34560905 PMCID: PMC8464129 DOI: 10.1186/s13098-021-00721-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Abnormal glucose metabolism including diabetes (DM) and prediabetes (pre-DM) have been reported as predictors of poorer outcomes after acute myocardial infarction (AMI). However, the prognostic value of pre-DM in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear. METHODS A total of 1179 MINOCA patients were prospectively recruited and divided into normoglycemia (NG), pre-DM, and DM groups according to glycated hemoglobin (HbA1c) levels or past history. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization and hospitalization for unstable angina or heart failure. Kaplan-Meier and Cox regression analyses were performed. RESULTS Patients with pre-DM and DM had a significantly higher incidence of MACE compared with NG group (10.8%, 16.1%, 19.4%; p = 0.003) over the median follow-up of 41.7 months. After multivariate adjustment, both pre-DM and DM were significantly associated with an increased risk of MACE (NG as reference; pre-DM: 1.45, 95% CI 1.03-2.09, p = 0.042; DM: HR 1.79, 95% CI 1.20-2.66, p = 0.005). At subgroup analysis, pre-DM remained a robust risk factor of MACE compared to NG. In addition, pre-DM had a similar impact as DM on long-term prognosis in patients with MINOCA. CONCLUSIONS Pre-DM defined as raised HbA1c was associated with a poor prognosis in patients with MINOCA. Routine assessment of HbA1c enables an early recognition of pre-DM and thus may facilitate risk stratification in this specific population.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Wenjian Ma
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Sizhuang Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Xuze Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, PR China.
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Gao S, Ma W, Huang S, Lin X, Yu M. Effect of Lipoprotein (a) Levels on Long-term Cardiovascular Outcomes in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries. Am J Cardiol 2021; 152:34-42. [PMID: 34130824 DOI: 10.1016/j.amjcard.2021.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/25/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022]
Abstract
The association between elevated lipoprotein(a) [Lp(a)] and poor outcomes in coronary artery disease (CAD) has been addressed for decades. However, little is known about the prognostic value of Lp(a) in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). A total of 1179 patients with MINOCA were enrolled and divided into low, medium, and high Lp(a) groups based on the cut-off value of 10 and 30mg/dL. The primary endpoint was major adverse cardiovascular events (MACE), a composite of all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier and Cox regression analyses were performed. Accuracy was defined as area under the curve (AUC) using a receiver-operating characteristic analysis. Patients with higher Lp(a) levels had a significantly higher incidence of MACE (9.5%, 14.6%, 18.5%; p = 0.002) during the median follow-up of 41.7 months. The risk of MACE also increased with the rising Lp(a) levels even after multivariate adjustment [low Lp(a) group as reference, medium group: hazard ratio (HR) 1.55, 95% confidence interval (CI): 1.02-2.40, p = 0.047; high group: HR 2.07, 95% CI: 1.32-3.25, p = 0.001]. Further, clinically elevated Lp(a) defined as Lp(a) ≥30 mg/dL was closely associated with an increased risk of MACE in overall and in subgroups (all p <0.05). When adding Lp(a) (AUC 0.61) into the Thrombolysis in Myocardial Infarction (TIMI) score (AUC 0.68), the combined model (AUC 0.73) yielded a significant improvement in discrimination for MACE (ΔAUC 0.05, p = 0.032). In conclusion, elevated Lp(a) was strongly associated with a poor prognosis in patients with MINOCA. Adding Lp(a) to traditional risk score further improved risk prediction. Our data, for the first time, confirmed the Lp(a) as a residual risk factor for MINOCA.
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Affiliation(s)
- Side Gao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjian Ma
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sizhuang Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuze Lin
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Pustjens TFS, Meerman A, Vranken NPA, Ruiters AW, Gho B, Stein M, Ilhan M, Veenstra L, Winkler P, Lux Á, Rasoul S, van 't Hof AWJ. Importance of confirming the underlying diagnosis in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): a single-centre retrospective cohort study. BMC Cardiovasc Disord 2021; 21:357. [PMID: 34320950 PMCID: PMC8320155 DOI: 10.1186/s12872-021-02176-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Many patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discharged without a known aetiology for their clinical presentation. This study sought to assess the effect of this 'indeterminate MINOCA' diagnosis on the prevalence of recurrent cardiovascular events and presentations to the Cardiac Emergency Department (CED). METHODS We retrospectively analysed all patients meeting the diagnostic MINOCA criteria presenting at a large secondary hospital between January 2017 and April 2019. PARTICIPANTS Patients were divided into the (1) 'indeterminate MINOCA', or (2) 'MINOCA with diagnosis' group. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke and any revascularisation procedure. Secondary outcomes were all recurrent visits at the CED, and MACE including unplanned cardiac hospitalisation. RESULTS In 62/198 (31.3%) MINOCA patients, a conclusive diagnosis was found (myocardial infarction, (peri)myocarditis, cardiomyopathy, or miscellaneous). MINOCA patients with a confirmed diagnosis were younger compared to those with an indeterminate diagnosis (56.7 vs. 62.3 years, p = 0.007), had higher maximum troponin-T [238 ng/L vs. 69 ng/L, p < 0.001] and creatine kinase (CK) levels [212U/L vs. 152U/L, p = 0.007], and presented more frequently with electrocardiographic signs of ischaemia (71.0% vs. 47.1%, p = 0.002). Indeterminate MINOCA patients more often showed recurrent CED presentations (36.8% vs. 22.6%, p = 0.048), however the occurrence of cardiovascular events was equal (8.8 vs. 8.1%, p = 0.86). Multivariable analysis showed that elevated levels of troponin-T and CK, ST-segment deviation on electrocardiography, reduced left ventricular ejection fraction, regional wall motion abnormalities, and performance of additional examination methods were independent predictors for finding the underlying MINOCA cause. CONCLUSIONS Only in one-third of MINOCA patients a conclusive diagnosis for the acute presentation was identified. Recurrent CED visits were more often observed in the indeterminate MINOCA group, while the occurrence of cardiovascular events was similar across groups. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- T F S Pustjens
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands.
| | - A Meerman
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - N P A Vranken
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A W Ruiters
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - B Gho
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - M Stein
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
| | - M Ilhan
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - L Veenstra
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Winkler
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Á Lux
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Rasoul
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A W J van 't Hof
- Department of Cardiology, Zuyderland Medical Centre, P.O. Box 5500, 6130 MB, Sittard-Geleen, Heerlen, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Mohammed AQ, Abdu FA, Liu L, Yin G, Xu B, Xu S, Feng C, Lv X, Fan R, Che W, Xu Y. Does Sex Influence Outcomes in Myocardial Infarction With Nonobstructive Coronary Arteries? Angiology 2021; 73:275-280. [PMID: 34231394 DOI: 10.1177/00033197211028428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examined differences in clinical profiles, predictors, and outcomes among patients with myocardial infarction (MI) with nonobstructive coronary arteries (MINOCAs) by sex. Data of 259 (132 males and 127 females) patients with MINOCA were consecutively collected. The primary clinical end point was major adverse cardiovascular events (MACE), including cardiovascular death, nonfatal MI, stroke, heart failure, and angina rehospitalization. Female patients with MINOCA were likely to be older than male patients with higher non-ST elevation myocardial infarction rate. Total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels were higher in female patients while male patients were more likely to have a smoking history, greater ST elevation myocardial infarction rate, higher diastolic blood pressure, and more alcohol use. During the 2-year follow-up, the incidence of MACE in males and females was similar (18% vs 20.2%, respectively; P = .673). The multivariable predictors of MACE in the female group were age, hypertension, and left ventricular ejection fraction (LVEF), whereas diabetes, smoking, and LVEF were multivariable predictors of MACE in the male group. In conclusion, there were differences in the clinical profiles between sexes. Clinical outcome was similar between male and female patients with MINOCA, whereas predictive risk factors varied.
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Affiliation(s)
- Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cailin Feng
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
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Gao S, Ma W, Huang S, Lin X, Yu M. Predictive value of the age, creatinine, and ejection fraction score in patients with myocardial infarction with nonobstructive coronary arteries. Clin Cardiol 2021; 44:1011-1018. [PMID: 34061375 PMCID: PMC8259146 DOI: 10.1002/clc.23650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about risk stratification in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). We investigated whether the age, creatinine, and ejection fraction (ACEF) score (age [years]/ejection fraction [%] + 1 [if creatinine >176 μmol/L]) might predict long-term outcomes after MINOCA. HYPOTHESIS The ACEF score enables accurate risk prediction in patients with MINOCA. METHODS A total of 1179 patients with MINOCA were enrolled and divided based on their ACEF score tertile levels. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier and Cox regression analyses were performed. Discrimination was defined as the area under the curve (AUC) using receiver operating characteristic analysis. RESULTS During the median follow-up of 41.7 months, patients with MINOCA with higher ACEF score tertiles had a significantly higher incidence of MACE (6.3%, 12.5%, and 23.8%, respectively; p < .001). The adjusted risk of MACE increased with the rising ACEF score tertiles (1st tertile as reference; 2nd tertile: HR 2.70, 95% CI: 1.38-5.29, p = .004; and 3rd tertile: HR 5.35, 95% CI: 2.72-10.51, p < .001). Moreover, an elevated ACEF score was closely associated with an increased risk of MACE overall (HR 4.23, 95% CI: 3.37-5.30, p < .001) and in subgroups (all p < .05). The ACEF score also yielded a good predictive value (AUC 0.79) for MACE. CONCLUSION Elevated ACEF scores were strongly associated with a poor prognosis after MINOCA. This simple and valid risk score may facilitate risk stratification and decision making in the population with MINOCA.
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Affiliation(s)
- Side Gao
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wenjian Ma
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Sizhuang Huang
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xuze Lin
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mengyue Yu
- Department of CardiologyFuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Gao S, Ma W, Huang S, Lin X, Yu M. Sex-Specific Clinical Characteristics and Long-Term Outcomes in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries. Front Cardiovasc Med 2021; 8:670401. [PMID: 34179135 PMCID: PMC8221425 DOI: 10.3389/fcvm.2021.670401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Sex differences in clinical profiles and prognosis after acute myocardial infarction have been addressed for decades. However, the sex-based disparities among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remain largely unreported. Here, we investigated sex-specific characteristics and long-term outcomes in MINOCA population. Methods: A total of 1,179 MINOCA patients were enrolled, including 867 men and 312 women. The mean follow-up was 41.7 months. The primary endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, non-fatal reinfarction, revascularization, non-fatal stroke, and hospitalization for unstable angina or heart failure. Baseline data and outcomes were compared. Kaplan-Meier curves and Cox regression analyses were used to identify association between sex and prognosis. Results: Female patients with MINOCA had more risk profiles with regard to older age and higher prevalence of hypertension and diabetes compared with men. The evidence-based medical treatment was similar in men and women. The incidence of MACE (men vs. women: 13.8 vs. 15.3%, p = 0.504) did not differ significantly between the sexes. The Kaplan-Meier analysis also indicated that women had a similar incidence of MACE compared to men (log rank p = 0.385). After multivariate adjustment, female sex was not associated with the risk of MACE in overall (adjusted hazard ratio 1.02, 95% confidence interval: 0.72-1.44, p = 0.916) and in subgroups of MINOCA patients. Conclusion: The long-term outcomes were similar for men and women presenting with MINOCA despite older age and more comorbidities in women. Future research should aim to improve in-hospital and post-discharge care for both sexes with MINOCA.
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Affiliation(s)
- Side Gao
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjian Ma
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sizhuang Huang
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuze Lin
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mengyue Yu
- Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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42
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Yin G, Abdu FA, Liu L, Xu S, Xu B, Luo Y, Lv X, Fan R, Che W. Prognostic Value of GRACE Risk Scores in Patients With Non-ST-Elevation Myocardial Infarction With Non-obstructive Coronary Arteries. Front Cardiovasc Med 2021; 8:582246. [PMID: 33665209 PMCID: PMC7920981 DOI: 10.3389/fcvm.2021.582246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a special type of myocardial infarction (MI). The GRACE risk score is commonly used to predict major adverse cardiovascular events (MACE) in non-ST-elevation myocardial infarction patients, and the suitability of the GRACE risk score for prognostic stratification in patients with MINOCA remains uncertain. This study aimed to investigate whether the GRACE risk score is capable of predicting MACE in MINOCA patients with NSTE. We calculated the GRACE risk score for 340 consecutive MINOCA patients with NSTE. Patients were divided into a low-intermediate risk group (≤ 140, 48.8%) and a high risk group (>140, 51.2%) according to their GRACE risk scores. The clinical characteristics and outcomes of the patients were assessed. Patients in the high risk group tended to be older and to have more comorbidities. At the 1-year follow-up, the rate of cardiac death in the high risk group was significantly higher than that in the low-intermediate-risk group (p = 0.010). There was no significant difference in non-fatal MI, stroke, heart failure, or cardiovascular-related rehospitalization. The incidence of total MACE was significantly higher in patients with high GRACE risk scores than in patients with low GRACE risk scores (p = 0.006). ROC curve analysis showed that the GRACE risk score has moderate value in predicting MACE in NSTE-MINOCA patients. The area under the ROC curve was 0.710 (95% CI 0.625–0.796, P < 0.001). The GRACE risk score provides potentially valuable prognostic information on clinical outcome when applied to MINOCA patients with NSTE.
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Affiliation(s)
- Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, Clinical Medical College of Shanghai Tenth People's Hospital, Nanjing Medical University, Shanghai, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanru Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Cardiology, Shanghai Tenth People's Hospital Chongming Branch, Shanghai, China
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Fomina O, Pereverzeva K, Yakushin S. A patients after myocardial infarction with non-obstructive and obstructive coronary artery disease: adherence to treatment and long-term prognosis. PROFILAKTICHESKAYA MEDITSINA 2021; 24:70. [DOI: 10.17116/profmed20212407170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
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Gao S, Ma W, Huang S, Lin X, Yu M. Predictive Value of Free Triiodothyronine to Free Thyroxine Ratio in Euthyroid Patients With Myocardial Infarction With Nonobstructive Coronary Arteries. Front Endocrinol (Lausanne) 2021; 12:708216. [PMID: 34394005 PMCID: PMC8356082 DOI: 10.3389/fendo.2021.708216] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Thyroid function is closely involved in cardiovascular diseases. The free triiodothyronine (fT3) to free thyroxine (fT4) ratio has been reported as a risk factor for coronary artery disease, but its prognostic value in euthyroid patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remains unclear. METHODS A total of 1162 euthyroid patients with MINOCA were enrolled and divided according to decreased tertiles of fT3/fT4 ratio. The study endpoint was major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan-Meier, Cox regression, and receiver-operating characteristic analyses were performed. RESULTS Patients with lower fT3/fT4 tertile levels had a significantly higher incidence of MACE (10.0%, 13.9%, 18.2%; p=0.005) over the median follow-up of 41.7 months. The risk of MACE increased with the decreasing fT3/fT4 tertiles even after multivariate adjustment (tertile1 as reference, tertile2: HR 1.58, 95% CI: 1.05-2.39, p=0.030; tertile3: HR 2.06, 95% CI: 1.17-3.11, p=0.006). Lower level of fT3/fT4 ratio remained a robust predictor of MACE in overall (HR 1.64, 95% CI: 1.18-2.29, p=0.003) and in subgroups. When adding fT3/fT4 ratio [area under the curve (AUC) 0.61] into the thrombolysis in myocardial infarction (TIMI) risk score (AUC 0.69), the combined model (AUC 0.74) yielded a significant improvement in discrimination for MACE (ΔAUC 0.05, p=0.023). CONCLUSIONS Low level of fT3/fT4 ratio was strongly associated with a poor prognosis in euthyroid patients with MINOCA. Routine assessment of fT3/fT4 ratio may facilitate risk stratification in this specific population.
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Abdu FA, Mohammed AQ, Liu L, Zhang W, Yin G, Xu B, Xu S, Xu Y, Che W. Low Free Triiodothyronine as a Predictor of Poor Prognosis in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. Front Endocrinol (Lausanne) 2021; 12:681978. [PMID: 34135864 PMCID: PMC8202072 DOI: 10.3389/fendo.2021.681978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Low free triiodothyronine (fT3) level is strongly associated with poor prognosis in various patient populations. However, the role of fT3 in the risk of clinical outcomes in myocardial infarction with non-obstructive coronary arteries (MINOCA) has not been studied. Our study aimed to evaluate the association between low fT3 levels and the clinical outcomes of MINOCA patients. METHODS A total of 218 MINOCA patients without a history of thyroid disease were enrolled in the study. Demographic, baseline clinical data, thyroid hormones, and other biochemical parameters were assessed in all patients. According to the fT3 levels, the present study was classified into two groups: the low fT3 group (fT3<3.5 pmol/L) and the normal fT3 group (fT3 3.5-6.5 pmol/L). The endpoint of the study was major adverse cardiac events (MACE). RESULTS Fifty-nine patients were in the low fT3 group and 159 patients were in the normal fT3 group. Over the two years of follow-up, 36 MACE have occurred. The occurrence of MACE was higher in the low fT3 group compared with normal fT3 group (25.4% vs 13.2%; P=0.031). Kaplan-Meier survival curves showed a significantly increased risk of MACE in patients with low fT3 (log-rank P=0.027). Multivariable logistic regression analysis stated that high fT3 was independently associated with lower risk of MACE after two years of follow up (OR, 0.623; 95% CI, 0.399- 0.972; P=0.037). CONCLUSION Low fT3 levels were significantly associated with increased risk of MACE in patients with MINOCA. This finding suggests that the fT3 levels may serve as a potential biomarker in risk stratification of MINOCA patients.
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Affiliation(s)
- Fuad A. Abdu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wen Zhang
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Yawei Xu, ; Wenliang Che,
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Cardiology, Shanghai Tenth People’s Hospital Chongming Branch, Shanghai, China
- *Correspondence: Yawei Xu, ; Wenliang Che,
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Effect of Secondary Prevention Medication on the Prognosis in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. J Cardiovasc Pharmacol 2020; 76:678-683. [DOI: 10.1097/fjc.0000000000000918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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He CJ, Cao LF, Zhu CY, Dai XC, Yu YY, Zhu YJ, Zhai CL, Qian G, Hu HL. Association Between Obstructive Sleep Apnea-Hypopnea Syndrome and Outcomes in Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease. Front Cardiovasc Med 2020; 7:573819. [PMID: 33195461 PMCID: PMC7644470 DOI: 10.3389/fcvm.2020.573819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) occurs in 5-10% of all patients with acute myocardial infarction. Obstructive sleep apnea-hypopnea syndrome (OSAHS) is linked to increased cardiovascular morbidity and mortality, but the relationship of OSAHS and outcomes in patients with MINOCA remains unknown. We aimed to evaluate the association between OSAHS and clinical outcomes in patients with MINOCA. Methods: Between January 2015 and December 2016, we carried out a consecutive cohort study of 583 patients with MINOCA and followed them up for 3 years. An apnea-hypopnea index of ≥ 15 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSAHS. The primary end point was all-cause mortality, and the second end point was major adverse cardiovascular or cerebrovascular events (MACCE), a composite of cardiac death, non-fatal myocardial infarction, heart failure, cardiovascular-related rehospitalization, and stroke. Results: All-cause mortality happened in 69 patients and MACCE occurred in 113 patients during the 3-year follow-up. Kaplan-Meier survival curves indicated the significant relationship of OSAHS with all-cause mortality (log-rank P = 0.012) and MACCE (log-rank P = 0.002). Multivariate Cox regression analysis indicated OSAHS as an independent predictor of all-cause mortality and MACCE [adjusted hazard ratio: 1.706; 95% confidence interval (CI): 1.286-2.423; P = 0.008; and adjusted hazard ratio: 1.733; 95% CI: 1.201-2.389; P < 0.001; respectively], independent of age, sex, cardiovascular risk factors and discharge medications. Conclusions: OSAHS is independently associated with increased risk of all-cause mortality and MACCE in patients with MINOCA. Intervention and treatment should be considered to alleviate OSAHS-associated risk.
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Affiliation(s)
- Chao-Jie He
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Lin-Feng Cao
- Department of Respiration, The First Hospital of Jiaxing, The First Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Chun-Yan Zhu
- Department of Anesthesiology, The First Hospital of Jiaxing, The First Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xiao-Ce Dai
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Yue-Yan Yu
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Yu-Juan Zhu
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Chang-Lin Zhai
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Gang Qian
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
| | - Hui-Lin Hu
- Jiaxing Key Laboratory of Arteriosclerotic Diseases, Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing Institute of Arteriosclerotic Diseases, Jiaxing, China
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Effect of exercise-based cardiac rehabilitation on clinical outcomes in patients with myocardial infarction in the absence of obstructive coronary artery disease (MINOCA). Int J Cardiol 2020; 315:9-14. [DOI: 10.1016/j.ijcard.2020.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/14/2020] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
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Mechanisms of myocardial infarction with nonobstructive coronary atherosclerosis: a multifaceted play of different actors with guarded prognosis. Curr Opin Cardiol 2020; 35:697-704. [PMID: 32852344 DOI: 10.1097/hco.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Myocardial infarction (MI) with nonobstructive coronary atherosclerosis (MINOCA) on invasive angiography (stenosis severity <50%) is a heterogenous clinical entity with a prevalence between 6 and 8% of all MI. Whereas the long-term prognosis of MINOCA is not benign, the identification of its underlying mechanism is critical for appropriate risk stratification and tailored secondary prevention strategies. RECENT FINDINGS The current review summarizes the contemporary data on the mechanisms, diagnosis, management strategies and outcomes of MINOCA. SUMMARY MINOCA is a relatively common form of MI with guarded prognosis. The use of additional diagnostic tests (particularly intracoronary imaging and cardiac magnetic resonance) is paramount to determine the exact cause of MINOCA and implement tailored medical interventions.
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Gasior P, Desperak A, Gierlotka M, Milewski K, Wita K, Kalarus Z, Fluder J, Kazmierski M, Buszman PE, Gasior M, Wojakowski W. Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry. J Clin Med 2020; 9:E2779. [PMID: 32867273 PMCID: PMC7564426 DOI: 10.3390/jcm9092779] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). METHODS We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. RESULTS Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). CONCLUSIONS This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up.
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Affiliation(s)
- Pawel Gasior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Aneta Desperak
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.D.); (M.G.)
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, 45-401 Opole, Poland;
| | - Krzysztof Milewski
- Centre for Cardiovascular Research and Development, American Heart of Poland, 43-450 Ustron, Poland;
| | - Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland;
| | - Joanna Fluder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Maciej Kazmierski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Paweł E. Buszman
- Department of Epidemiology and Statistics, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.D.); (M.G.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
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