Prognosis of Patients With Non–ST-Segment–Elevation Myocardial Infarction and Nonobstructive Coronary Artery Disease

Abstract

Background-Troponin elevation is a risk factor for mortality in patients with non-ST-segment-elevation acute coronary syndromes.However, the prognosis of patients with troponin elevation and nonobstructive coronary artery disease (CAD) is unknown. Our objective was therefore to evaluate the impact of nonobstructive CAD in patients with non-ST-segment-elevation acute coronary syndromes and troponin elevation enrolled in the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial. Methods and Results-In the ACUITY trial, 3-vessel quantitative coronary angiography was performed in a formal substudy of 6921 patients presenting with non-ST-segment-elevation acute coronary syndromes. Patients with elevated admission troponin levels were stratified by the presence or absence of obstructive CAD (any lesion with quantitative diameter stenosis >50%

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study

“…They also had similar lengths of hospital stay, possibly as a result of further testing of MINOCA patients to enhance management. Prior studies have shown lower mortality with MINOCA (3.2–4.5%) than with MI‐CAD 3, 6, 7, 9. We observed lower mortality in VIRGO patients 5, 48, 49, 50.…”

“…In contrast, patients with vasospasm more often reported recurrent angina, illicit drug use, and pregnancy‐related complications. With 1 in 10 young patients with AMI diagnosed with MINOCA,3, 4, 5, 6, 7, 8 our findings highlight both the challenges and the importance of pursuing a systematic approach to identify the underlying cause (coronary‐ischemic, non–coronary‐ischemic or nonischemic, or noncardiac) 13, 36…”

“…Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) constitute 6% to 14% of all those with acute myocardial infarction (AMI) 1, 2, 3, 4, 5, 6, 7, 8. Recent evidence demonstrates that patients with MINOCA are distinct from patients with AMI with the classic culprit lesion—namely, >50% plaque‐mediated occlusion of the coronary artery (myocardial infarction due to coronary artery disease [MI‐CAD])—by having lower prevalence of the traditional cardiac risk factors and a lower but clinically significant annual mortality rate 1, 5, 6.…”

Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): It's Time to Face Reality!

“…A sizeable minority of patients with AMI are found to have MINOCA 3, 4, 5, 6, 7, 8, 9, 10, 11. Unfortunately, some physicians fail to realize that the absence of obstructive coronary arteries does not exclude the possibility of an AMI.…”

“…MINOCA is found in roughly 6% of AMI patients4; however, there is large variability in its reported prevalence, with a range of 3.5% to 15%,3, 4, 5, 6, 7, 8, 9, 10, 11 possibly attributable to differences in the studied populations and heterogeneity in its definition. MINOCA is also more common in younger patients and women 3, 4, 5, 6, 7.…”