Prognostic Value of Cardiac Magnetic Resonance Imaging in Acute Coronary Syndrome Patients With Troponin Elevation and Nonobstructive Coronary Arteries

Luis, Sushil Allen; Luis, Chris R.; Habibian, M.; Lwin, M.; Gadowski, T.; Chan, Jonathan; Hamilton-Craig, C.; Raffel, O.

doi:10.1016/j.mayocp.2020.11.026

Cited by 10 publications

(9 citation statements)

References 18 publications

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“…CMRI is recommended by the ESC guidelines in all MINOCA cases where a diagnosis is uncertain (2). CMRI provides an appropriate diagnosis in 74-87% of all MINOCA patients (74,(83)(84)(85)(86)(87). CMRI subendocardial (or transmural) pattern of myocardial edema, inflammation, or fibrosis is suggestive of ischemic MI, whereas an epicardial pattern is suggestive of non-ischemic MI (81).…”

Section: Cardiac Imagingmentioning

confidence: 99%

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Yildiz

Ashokprabhu

Shewale

et al. 2022

Front. Cardiovasc. Med.

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Myocardial infarction with non-obstructive coronary arteries (MINOCA) is evident in up to 15% of all acute myocardial infarctions (AMI) and disproportionally affects females. Despite younger age, female predominance, and fewer cardiovascular risk factors, MINOCA patients have a worse prognosis than patients without cardiovascular disease and a similar prognosis compared to patients with MI and obstructive coronary artery disease (CAD). MINOCA is a syndrome with a broad differential diagnosis that includes both ischemic [coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), and coronary embolism/thrombosis] and non-ischemic mechanisms (Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy)—the latter called MINOCA mimickers. Therefore, a standardized approach that includes multimodality imaging, such as coronary intravascular imaging, cardiac magnetic resonance, and in selected cases, coronary reactivity testing, including provocation testing for coronary vasospasm, is necessary to determine underlying etiology and direct treatment. Herein, we review the prevalence, characteristics, prognosis, diagnosis, and treatment of MINOCA -a syndrome often overlooked.

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Section: Cardiac Imagingmentioning

confidence: 99%

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Yildiz

Ashokprabhu

Shewale

et al. 2022

Front. Cardiovasc. Med.

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“…However, there is a debate as to whether antiplatelet agents should be routinely prescribed to patients with MINOCA. Luis et al reported that insu cient secondary prevention medications (e.g., aspirin) were responsible for the poor outcome among MINOCA patients with "normal" cardiac magnetic resonance images [40]. On the contrary, a post-hoc analysis of the CURRENT-OASIS 7 trial showed that potent antiplatelet therapy might increase the risk of cardiovascular events [41].…”

Section: Discussionmentioning

confidence: 99%

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Fan

Mao

Zhou

et al. 2022

Preprint

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PurposeThe effect of aspirin therapy in patients with nonobstructive coronary artery disease (CAD) remains controversial. This study aimed to investigate the association between aspirin therapy and prognosis in nonobstructive CAD.MethodsWe searched for observational cohort studies on Pubmed, Embase, the Cochrane Library and Web of Science. Studies were included that compared the endpoint differences in patients with nonobstructive CAD who were treated with aspirin or not. The primary endpoint was a composite of major adverse cardiovascular events (MACEs). Secondary endpoints included all-cause death, cardiovascular death and myocardial infarction (MI). The pooled effect size was estimated as hazard ratio (HR) with 95% confidence interval (CI), which was measured by a random effect model using the generic inverse variance method.ResultsThirteen published studies with 34,463 patients were included. Pooled data showed that aspirin therapy was not associated with the risk of MACEs (HR 1.10; 95% CI 0.85–1.41; P = 0.47, I2 = 57%). Similar results were observed in cardiovascular death (HR 1.12; 95% CI 0.73–1.73; P = 0.60, I2 = 0%) and MI (HR 0.53; 95% CI 0.09–3.20; P = 0.49, I2 = 68%), except all-cause death (HR 0.77; 95% CI 0.63–0.95; P = 0.02, I2 = 25%). Subgroup analyses showed that there were no associations between aspirin therapy and MACEs in all subsets.ConclusionsRoutine aspirin therapy might not improve prognosis in patients with nonobstructive CAD. Aspirin therapy in non-obstructive CAD should be better investigated and future research is needed. A personalized antiplatelet regimen might contribute to reduction in ischemic cardiovascular events in patients with non-obstructive CAD.Registration: PROSPERO (CRD42021281706).

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“…However, there is a debate as to whether antiplatelet agents should be routinely prescribed to patients with MINOCA. Luis et al reported that insu cient secondary prevention medications (e.g., aspirin) were responsible for the poor outcome among MINOCA patients with "normal" cardiac magnetic resonance images [32]. On the contrary, a post-hoc analysis of the CURRENT-OASIS 7 trial showed that potent antiplatelet therapy might increase the risk of cardiovascular events [33].…”

Section: Discussionmentioning

confidence: 99%

“…A personalized antiplatelet regimen might contribute to reduction in ischemic cardiovascular events for these patients. Olesen 2021 [20] (Denmark) Gu 2021 [33] (China) Ciliberti 2021 [32] (Italy) Paolisso 2020 [21] (Italy) Lee 2018 [22] (South Korea) KAMIR 2016 [30] (South Korea) Ishii 2016 [23] (Japan) Lim 2016 [29] (South Korea) Hwang 2015 [19] (South Korea)…”

Section: Discussionmentioning

confidence: 99%

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Association of aspirin therapy with prognosis in patients with non obstructive coronary artery disease: A systematic review and meta-analysis

Jin¹

2022

J Clin Images Med Case Rep

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Background: The effect of aspirin therapy in patients with nonobstructive Coronary Artery Disease (CAD) remains controversial. This study aimed to investigate the association between aspirin therapy and prognosis in nonobstructive CAD. Methods: We searched for observational cohort studies on Pubmed, Embase, the Cochrane Library and Web of Science. Studies were included that compared the endpoint differences in patients with nonobstructive CAD who were treated with aspirin or not. The primary endpoint was a composite of Major Adverse Cardiovascular Events (MACEs). Secondary endpoints included all-cause death, cardiovascular death and Myocardial Infarction (MI). The pooled effect size was estimated as Hazard Ratio (HR) with 95% Confidence Interval (CI), which was measured by a random effect model using the generic inverse variance method. Results: Thirteen published studies with 34,463 patients were included Pooled data showed that aspirin therapy was not associated with the risk of MACEs (HR 1.10; 95% CI 0.85–1.41; P=0.47, I2=57%). Similar results were observed in cardiovascular death (HR 1.12; 95% CI 0.73–1.73; P=0.60, I2=0%) and MI (HR 0.53; 95% CI 0.09–3.20; P=0.49, I2=68%), except all-cause death (HR 0.77; 95% CI 0.63–0.95; P=0.02, I2=25%). Subgroup analyses showed that there were no associations between aspirin therapy and MACEs in all subsets. Conclusions: Routine aspirin therapy might not be associated with a decreased risk of cardiovascular events in patients with nonobstructive CAD. Aspirin therapy in non-obstructive CAD should be better investigated and future research is needed. A personalized antiplatelet regimen may contribute to reduction in ischemic cardiovascular events for these patients.

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Prognostic Value of Cardiac Magnetic Resonance Imaging in Acute Coronary Syndrome Patients With Troponin Elevation and Nonobstructive Coronary Arteries

Cited by 10 publications

References 18 publications

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Association of Aspirin Therapy with Prognosis in Patients with Nonobstructive Coronary Artery Disease: A Systematic Review and Meta-Analysis

Association of aspirin therapy with prognosis in patients with non obstructive coronary artery disease: A systematic review and meta-analysis

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