<p>Characteristics of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA ) from the ARIAM-SEMICYUC registry: development of a score for predicting MINOCA</p>

Abstract

BackgroundAcute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy.Patients and methodsA multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree.ResultsA score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer–Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients.ConclusionPatients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures.

Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

“…9 Nowadays with the common use of coronary angiography in MI, clinicians are regularly confronted with MINOCA which represents a puzzling diagnosis, including heterogeneous patients with many potential etiologies that need to be investigated. 10 The prevalence of MINOCA in our study was 13.5% which is in line with study by Pasquale Paolisso et al (12%), 10 Roberta Rossini et al (13 %) 11 and Peter R Barr et al (15%) 9 but higher compared to studies by Daniel Ballesteros-Ortega et al (6%), 8 Rachel P Dreyer et al (5.9%) 12 and Salih kilic et al (6.7%). 1 Nonavailability of CT coronary angiography during study period for low risk young patients with atypical chest pain and subtle ST elevation in anterior leads, as J-point elevation is common in this age group that required diagnostic coronary angiogram, could be the reason for high prevalence of MINOCA in our study.…”

“…Similar to many previous studies, MINOCA patients were younger (Mean age 46.17±11.74 years). 8,9,10 Patients with MINOCA were more likely to be female and such association was statistically significant in many studies. 8,11 However we found no gender differences between two groups with male predominance in both.…”

“…8,9,10 Patients with MINOCA were more likely to be female and such association was statistically significant in many studies. 8,11 However we found no gender differences between two groups with male predominance in both. Males are more privileged to have access to health care facility and further expensive investigatory test and treatment in our society, so females may have under-represented in our study.…”

Machine learning as a tool for diagnostic and prognostic research in coronary artery disease

“…Даная модель показала повышение точности в верификации обструктивного поражения КА по индикаторам С-статистики: у женщин до 0,79 vs 0,66 для FRS; у мужчин до 0,83 vs 0,61 для FRS [25]. В другой работе с помощью ЛР была разработана диагностическая шкала для определения вероятности обнаружения интактных КА при ИМ [26]. Метод ЛР применяли в модели прогнозирования нарушений проводимости сердца, где в качестве предикторов были использованы генотипы транскрипционного фактора TBX5.…”

Ethiopathogenesis and prognostic implication in myocardial infarction without obstruction of the epicardial coronary arteries (MINOCA)

“…Por lo tanto, el diagnóstico de MINOCA debe considerarse un trabajo diagnóstico en equipo y su causa subyacente debe investigarse detalladamente . (9)(10)(11)(12)(13)(14) En una revisión sistemática de estudios, la prevalencia de MINOCA entre pacientes con un infarto de miocardio fue 1 a 14%, con una media 6%. Sin embargo, cabe notar que la prevalencia varía ampliamente entre los distintos estudios .…”