Acute Myocardial Infarction with Non-Obstructive Coronary Arteries – Stratifying the Risk of a “new” Clinical Entity using an “Old” Tool

Abstract

Background: Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives:To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population.Methods: This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) -a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results:Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion:The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Seguimiento de una cohorte de pacientes con síndrome coronario agudo sin enfermedad coronaria obstructiva

“…En nuestro estudio fue más común encontrar la FEVI preservada (≥50%), la cual se presentó en 81.6% (n=133) de los registros, hallazgo similar con lo descrito en las diferentes series donde se reporta una FEVI preservada que varía desde 72.4% hasta 91.8% (20,24).…”

“…Sin embargo, en los últimos años los diferentes estudios publicados han refutado esta hipótesis y han comprobado que sus resultados no son buenos al compararlos con sujetos sin MINOCA (5). En diferentes registros se ha informado una tasa de mortalidad por cualquier causa a 12 meses de 4.7% (2.6-6.9%) (7), de 5.3% en el estudio COAPT (2018) (21) y de 5.5% en el registro Portugués (20), hallazgos semejantes a los documentados en el presente estudio con una mortalidad al año por causa cardiovascular de 4.8% (n=7).…”