Long-term prognosis in patients suffering from myocardial infarction with non-obstructive coronary arteries, ST-segment elevation myocardial infarction, infective myocarditis and tako-tsubo cardiomyopathy – all-cause mortality comparison

Abstract

IntroductionMyocardial infarction with non-obstructive coronary arteries (MINOCA), tako-tsubo cardiomyopathy (TTC), infective myocarditis (IM) and acute ST-segment elevation myocardial infarction (STEMI) of anterior wall being a heterogeneous group, may occur in very similar clinical presentations. In this study, it was aimed to compare the prognosis and identify predictors of major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality in these groups of patients.Material and methodsAt 2 Polish Academic Cardiology Centres among 596 patients, we compared clinical characteristics and outcomes in 4 groups: MINOCA (318, 53.3%), TTC (31, 5.2%), IM (22, 3.7%) and STEMI (225, 37.7%). MACCE were defined as myocardial infarction (MI), revascularisation (either percutaneous or surgical), all-cause death and stroke/transient ischemic attacks. Survival curves were presented using Kaplan-Meier estimator and compared using log-rank test.ResultsKaplan-Meier survival analysis demonstrated that in the 3-year follow-up period, patients with anterior wall STEMI were at the highest risk of MACCE (p < 0.001). During the follow-up period, the greatest mortality rate was observed in the TTC group, however, this was without statistical significance. Multivariable regression analysis showed that long-term mortality was significantly related to age (p < 0.001), creatinine level (p < 0.001), platelet count (p < 0.001), white blood cells (p < 0.001) and hyperlipidaemia (p = 0.001).ConclusionsDuring the 3 years of follow-up, anterior wall STEMI had significantly poorer prognosis in terms of MACCE when compared to the TTC, IM and MINOCA groups. TTC was related to the greatest all-cause mortality, however, without statistical significance.