Myocardial infarct size and sex-related angiographic differences in myocardial infarction in nonobstructive coronary artery disease

Abstract

Background Myocardial infarction in nonobstructive coronary artery disease (MINOCA) is a recently described infarct subtype. There are few studies that examine coronary artery disease (CAD) extent, MI size and type, and treatment differences at hospital discharge compared to myocardial infarction in obstructive coronary artery disease (MICAD), or that explore sex-specific MINOCA attributes of coronary anatomy and infarct size. Methods Our study population consisted of a single tertiary-center of consecutive patients that had coronary angiography for acute MI between 2005 and 2015. The MI type at presentation, MI size and ejection fraction (post-MI), and gender differences between MINOCA patients were examined. Result Among 1698 cases with acute MI, 95 had MINOCA (5.6%). MINOCA patients were younger, more often had NSTEMI, lower peak cardiac troponin (cTn) values, and greater ejection fraction than MICAD patients (all P-values <0.005). At hospital discharge, 30-day re-admission rates were similar. MINOCA patients less frequently received optimal medical therapy. When women were analyzed, the 45 women with MINOCA had smaller MIs (P < 0.001) and greater ejection fraction (P = 0.002) than the 358 women with MICAD. Sex comparisons of the 95 MINOCA patients revealed women were older than men (P < 0.001), had lower mean peak cTn values (P < 0.001), greater ejection fraction (P = 0.02), and more single-vessel disease involvement than men (P < 0.0001). Conclusion The average MI size is smaller in MINOCA than MICAD patients, and there are sex-related differences in clinical presentation, coronary artery disease extent, and MI size. Re-admission rates are similar and MINOCA patients are less likely to receive guideline recommended medical therapy at discharge.

Clinical Characteristics and Long-Term Outcomes of MINOCA Accompanied by Active Cancer: A Retrospective Insight Into a Cardio-Oncology Center Registry

“…This indirectly indicates a lower myocardial injury rate and most likely a smaller infarct size in patients with MINOCA. These findings are in line with previous data showing that, among the MINOCA population, patients with heart failure with preserved LV ejection fraction ( 34 , 35 ) predominated. Post-infarction myocardial remodeling is also less frequently observed in this group.…”

Myocardial Infarction Signs and Symptoms: Females vs. Males

“…Females with MINOCA are on average eight years older and have smaller MIs than males. Females also have significantly less multivessel disease than males (30% of females vs. 90% of males), which is consistent with the decreased prevalence of atherosclerotic plaques in females versus males [ 58 ]. When in an enhanced systemic inflammatory state (measured by increased vertebral bone marrow activity as a surrogate for leukocyte production) females have decreased myocardial perfusion and decreased left ventricular systolic function whereas no such decrease is seen in males [ 59 ].…”

“…Coronary perfusion differences between males and females also impact MI feature differences. About 5-10% of MIs are considered to occur with nonobstructive coronary artery disease (myocardial infarction with no obstructive coronary artery disease (MINOCA)) [ 58 ]. MINOCA patients are younger, have more NSTEMI events, have lower cardiac troponin levels, and have greater ejection fractions than obstructive MI patients.…”