TY - JOUR
T1 - Myocardial Infarction With No Obstructive Coronary Artery Disease
T2 - Angiographic and Clinical Insights in Patients With Premature Presentation
AU - Raparelli, Valeria
AU - Elharram, Malik
AU - Shimony, Avi
AU - Eisenberg, Mark J.
AU - Cheema, Asim N.
AU - Pilote, Louise
N1 - Publisher Copyright:
© 2018 Canadian Cardiovascular Society
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background: Premature myocardial infarction (MI) is an increasingly prevalent cause of morbidity and mortality worldwide. A subset of patients, predominantly young women, present with MI with no obstructive coronary artery disease (MINOCA), a nomenclature gaining recognition. However, few data exist on presentation and prognosis according to the severity of coronary artery disease (CAD). Methods: We studied patients with premature (younger than 55 years of age) acute MI enrolled in a large cohort in 24 centres across Canada. Baseline clinical, psychosocial, and coronary anatomy characteristics as well as 12-month outcomes were compared between patients with MINOCA (< 50% stenosis) and patients with MI with obstructive CAD (≥ 50% stenosis; MICAD). Results: From a cohort of 1210 patients with acute coronary syndrome, we examined 998 MI patients with available angiography core lab readings: 82 (8.2%) had a MINOCA and 916 (91.8%) had a MICAD. Forty percent of patients with MINOCA were women compared with one-third with MICAD. The prevalence of traditional risk factors and chest pain at presentation was lower in MINOCA patients, yet 37% had a ST-elevation MI and 10% presented with a cardiac arrest. No evident etiology was detected in > 70% of MINOCA, but 10% presented with either spontaneous coronary dissection or Takotsubo cardiomyopathy. Although combined major adverse cardiovascular events and all-cause readmission rate was lower in the MINOCA group (14% vs 25%; adjusted hazard ratio, 0.51; 95% confidence interval, 0.28-0.93), it was not negligible. Conclusions: Patients with MINOCA present with high-risk features despite the absence of obstructive CAD. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in young women with premature MI.
AB - Background: Premature myocardial infarction (MI) is an increasingly prevalent cause of morbidity and mortality worldwide. A subset of patients, predominantly young women, present with MI with no obstructive coronary artery disease (MINOCA), a nomenclature gaining recognition. However, few data exist on presentation and prognosis according to the severity of coronary artery disease (CAD). Methods: We studied patients with premature (younger than 55 years of age) acute MI enrolled in a large cohort in 24 centres across Canada. Baseline clinical, psychosocial, and coronary anatomy characteristics as well as 12-month outcomes were compared between patients with MINOCA (< 50% stenosis) and patients with MI with obstructive CAD (≥ 50% stenosis; MICAD). Results: From a cohort of 1210 patients with acute coronary syndrome, we examined 998 MI patients with available angiography core lab readings: 82 (8.2%) had a MINOCA and 916 (91.8%) had a MICAD. Forty percent of patients with MINOCA were women compared with one-third with MICAD. The prevalence of traditional risk factors and chest pain at presentation was lower in MINOCA patients, yet 37% had a ST-elevation MI and 10% presented with a cardiac arrest. No evident etiology was detected in > 70% of MINOCA, but 10% presented with either spontaneous coronary dissection or Takotsubo cardiomyopathy. Although combined major adverse cardiovascular events and all-cause readmission rate was lower in the MINOCA group (14% vs 25%; adjusted hazard ratio, 0.51; 95% confidence interval, 0.28-0.93), it was not negligible. Conclusions: Patients with MINOCA present with high-risk features despite the absence of obstructive CAD. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in young women with premature MI.
UR - http://www.scopus.com/inward/record.url?scp=85044147938&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2018.01.004
DO - 10.1016/j.cjca.2018.01.004
M3 - Article
C2 - 29571427
AN - SCOPUS:85044147938
SN - 0828-282X
VL - 34
SP - 468
EP - 476
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 4
ER -