Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non‐Obstructive Coronary Arteries

Abstract

Background Myocardial infarction with nonobstructive coronary arteries ( MINOCA ) is a heterogeneous disease entity. Its prognosis and predictor of mortality remain unclear. This study aimed to compare the prognosis between MINOCA and myocardial infarction with obstructive coronary artery disease and identify factors related to all‐cause death in MINOCA using a nation‐wide, multicenter, and prospective registry. Methods and Results Among 13 104 consecutive patients enrolled, patients without previous history of significant coronary artery disease who underwent coronary angiography were selected. The primary outcome was 2‐year all‐cause death. Secondary outcomes were cardiac death, noncardiac death, reinfarction, and repeat revascularization. Patients with MINOCA (n=396) and myocardial infarction with obstructive coronary artery disease (n=10 871) showed similar incidence of all‐cause death (9.1% versus 8.8%; hazard ratio [ HR ], 1.04; 95% CI, 0.74–1.45; P =0.83). Risks of cardiac death, noncardiac death, and reinfarction were not significantly different between the 2 groups ( HR , 0.82; 95% CI , 0.53–1.28; P =0.38; HR , 1.55; 95% CI , 0.93–2.56; P =0.09; HR , 1.23; 95% CI , 0.65–2.31; P =0.38, respectively). MINOCA patients had lower incidence of repeat revascularization (1.3% versus 7.2%; HR , 0.17; 95% CI , 0.07–0.41; P <0.001). Results were consistent after multivariable regression and propensity‐score matching. In a multivariate model, several significant predictors of all‐cause death of MINOCA were found, including the nonuse of renin‐angiotensin system blockers ( HR , 2.63; 95% CI , 1.08–6.25; P =0.033) and statins ( HR , 2.17; 95% CI , 1.04–4.54; P =0.039). Conclusions Patients with MINOCA and those with myocardial infarction with obstructive coronary artery disease had comparable clinical outcomes. Use of renin‐angiotensin system blockers and statins was associated with lower mortality in patients with MINOCA .

Secondary Prevention Medical Therapy and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Artery Disease

“…MINOCA long-term prognosis is not event-free, with an approximate 9.2% rate of MACE per year (Baron et al, 2016;Pizzi et al, 2016;Choo et al, 2019). Interestingly, Kang et al confirmed that 12-month major adverse cardiac events (death and myocardial infarction) in patients with MINOCA were comparable to those of patients with MI associated with single-or double-vessel coronary artery disease (Kang et al, 2011).…”

“…In three observational studies, ACEI/angiotensin Receptor Blockers (ARB) therapy has demonstrated a beneficial effect on outcome in patients with MINOCA (Manfrini et al, 2014;Lindahl et al, 2017;Choo et al, 2019). However, these studies have some potential biases, such as the diagnosis of MINOCA that includes other conditions without acute ischemia, and the long period of enrolment in which the diagnostic criteria of MI were refined.…”

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

“…Incidencia acumulada de resultados primarios y secundarios en pacientes con MINOCA (13) Curvas de Kaplan-Meier con riesgos acumulativos de (A) muerte por todas las causas, (B) MI, (C) muerte o MI, y (D) cualquier revascularización repetida. MI indica infarto de miocardio; MI-CAD, infarto de miocardio con enfermedad obstructiva de la arteria coronaria; MINOCA, infarto de miocardio con arterias coronarias no obstructivas.…”

“…Choo EH et al en representación del estudio de investigación KAMIR-IH utilizaron modelos de (13) riesgo proporcional de Cox multivariable para identificar los predictores independientes de muerte por todas las causas en 2 años en pacientes con MINOCA. Ellos observaron que la vejez, síntomas atípicos, elevación del segmento ST en el ECG, Killip Clase IV y diabetes mellitus fueron predictores independientes de muerte por cualquier causa a los 2 años.…”

“…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 .…”