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

Abstract

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity with relevant long-term major cardiovascular events. Several trials have demonstrated that dual antiplatelet therapy (DAPT), b-blocker, renin-angiotensinaldosterone system (RAAS) inhibitor and statin therapy improve the prognosis in patients with obstructive myocardial infarction (ob-MI). However, evidence on the best medical therapy for secondary prevention in MINOCA patients is lacking. Purpose: To investigate the effects of secondary prevention treatments at discharge on mid-term outcomes in MINOCA. Methods: Patients with acute myocardial infarction (MI) undergoing early coronary angiography between 2016 and 2018 were extracted from a clinical database. The diagnosis of MINOCA was made according to 2016 ESC MINOCA Position Paper criteria. Second-level diagnostic work-up including cardiac magnetic resonance was performed to exclude non-ischemic troponin elevation cause. The relationship between treatments and outcomes was evaluated by using Kaplan-Meier survival analysis and Cox regression models. All confirmed MINOCA were followed in our outpatient clinics. The primary endpoints were all-cause mortality, re-hospitalization for MI and a composite outcome including all-cause mortality, hospitalization for MI and ischemic stroke (MACE). Results: Out of 1,141 AMI who underwent coronary angiography, 134 were initially diagnosed as MINOCA. Patients with MINOCA were less likely to receive secondary prevention treatments than patients with obstructive coronary artery disease (CAD) MI (respectively, 42.1% vs 81.8% for DAPT; 75.5% vs 89.6% for b-blockers; 64.7% vs 80.3% for RAAS inhibitor and 63.9% vs 83% for statins). Based on the diagnostic work-up completed during the first month after discharge, a final sample of 88 patients had confirmed MINOCA. During an average follow-up of 19.35 ± 10.65 months, all-cause

Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

“…9 Nowadays with the common use of coronary angiography in MI, clinicians are regularly confronted with MINOCA which represents a puzzling diagnosis, including heterogeneous patients with many potential etiologies that need to be investigated. 10 The prevalence of MINOCA in our study was 13.5% which is in line with study by Pasquale Paolisso et al (12%), 10 Roberta Rossini et al (13 %) 11 and Peter R Barr et al (15%) 9 but higher compared to studies by Daniel Ballesteros-Ortega et al (6%), 8 Rachel P Dreyer et al (5.9%) 12 and Salih kilic et al (6.7%). 1 Nonavailability of CT coronary angiography during study period for low risk young patients with atypical chest pain and subtle ST elevation in anterior leads, as J-point elevation is common in this age group that required diagnostic coronary angiogram, could be the reason for high prevalence of MINOCA in our study.…”

“…Similar to many previous studies, MINOCA patients were younger (Mean age 46.17±11.74 years). 8,9,10 Patients with MINOCA were more likely to be female and such association was statistically significant in many studies. 8,11 However we found no gender differences between two groups with male predominance in both.…”

Hyperglycemia, inflammatory response and infarct size in obstructive acute myocardial infarction and MINOCA

“…AMI was diagnosed in the presence of an increase and/or decrease of cardiac biomarker (troponin I high sensitivity—Tn I Hs) with at least one value above the 99th percentile upper reference limit associated with one of the following: symptoms of ischemia, new or presumed new significant ST-segment–T wave changes or new left bundle branch block, development of pathological Q waves in the EKG, and imaging evidence of new loss of viable myocardium or new regional wall motion abnormality [ 16 , 17 ]. MINOCA was diagnosed according to the 2016 ESC MINOCA Position Paper criteria [ 18 , 19 ]. Patients whose admission glycemia was not available were excluded from the study.…”

Myocardial Infarction with Nonobstructive Coronary Artery Disease—Definition, Etiopathogenesis, Diagnosis, and Management

“…Duration a median follow-up of 19 months, ACEi/ARB use was again noted to be associated with a 71% reduction in MACE but single or DAPT, BB, and statins did not show significant benefit. 53 This beneficial effect of renin-angiotensin-aldosterone blockade in MINOCA is not well understood but could be related to its inhibitory effect on sympathetic stimulation and its role in improving coronary microvascular function, apart from anti-inflammatory and antifibrotic properties.…”