Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches

Хоанг, Ч. Х.; Лазарев, П. В.; Майсков, В. В.; Мерай, И.А.; Кобалава, Ж. Д.

doi:10.20996/1819-6446-2019-15-6-881-891

Racionalʹnaâ farmakoterapiâ v kardiologii

2020

DOI: 10.20996/1819-6446-2019-15-6-881-891

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Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches

Ч. Х. Хоанг

П. В. Лазарев

В. В. Майсков

et al.

Abstract: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is diagnosed in the absence of anatomically significant stenoses (<50% of lumen diameter) on coronary angiography and characterized by heterogeneity of etiologic factors. Recently, the mechanisms of MINOCA as well as the performance of diagnostic algorithms and therapeutic strategies have been extensively studied. The purpose of this review is to reflect the current concepts regarding the etiology and pathogenesis of MINOCA, diagnostic wo… Show more

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Cited by 2 publications

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Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

Суспицына¹,

Сукманова²,

Safonova³

2023

Kardiologiia

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Aim. To evaluate clinical, anamnestic and laboratory data and the incidence rate of complications in patients with myocardial infarction (MI) without obstructive coronary artery (CA) disease.Material and methods. This study included 158 patients with MI without obstructive CA disease (main group), 150 patients with MI and obstructive CA disease (comparison group), and 55 patients without documented ischemic heart disease (IHD) (control group). Clinical and anamnestic data, carbohydrate and lipid metabolism, concentrations of high-sensitivity troponin and C-reactive protein (CRP) were evaluated, and electrocardiography, Holter electrocardiogram monitoring, echocardiography, and coronary angiography were performed for all patients.Results. The incidence rate of MI without obstructive CA disease was 1.9%, which was in general consistent with international data. Patients with MI without obstructive CA disease were somewhat younger than patients of the comparison group. Traditional risk factors, such as arterial hypertension (AH), acute cerebrovascular disease, diabetes mellitus (DM), and obesity were more frequently observed in patients with MI and obstructive CA disease, but the body weight index was significantly higher in MI patients without obstructive CA disease. The multivariate regression analysis identified the most significant factors associated with the development of MI in the group without obstructive CA disease: lipid metabolism disorders, AH, DM, male gender, smoking, and family history of IHD. Patients with MI without obstructive CA disease had a lower troponin level but a higher CRP level. Patients with MI without obstructive CA disease had a higher left ventricular (LV) ejection fraction (EF); acute heart failure (AHF), acute LV aneurism, and arrhythmias were the most frequent complication in this group.Conclusion. Patients with MI without obstructive CA disease had a higher LV EF, and their most frequent complications were AHF, acute LV aneurism, and arrhythmias.

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Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

Суспицына¹,

Сукманова²,

Safonova³

2023

Kardiologiia

View full text Add to dashboard Cite

show abstract

Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

Hoang,

Maiskov,

Merai

et al. 2024

Kardiologiia

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Aim. To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA).Material and methods. This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years.Results. MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042).Conclusion. The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.

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Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches

Cited by 2 publications

References 72 publications

Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

Clinical and Laboratory Parameters and Complication Rates In Patients With Myocardial Infarction Without Obstructive Coronary Artery Disease

Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries

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