The importance of evaluating patients with MINOCA (myocardial infarction with non-obstructive coronary arteries)

Sheikh, A.; Sidharta, S.; Worthley, M.; Yeend, Richard; Fiore, David Di; Beltrame, John F.

doi:10.1016/j.ijcard.2015.07.035

Cited by 15 publications

(15 citation statements)

References 10 publications

(9 reference statements)

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“…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…”

Section: Discussionmentioning

confidence: 87%

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

Safdar

Spatz

Dreyer

et al. 2018

JAHA

Self Cite

331

233

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BackgroundWe compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI‐CAD]) and among patients with MINOCA by sex and subtype.Methods and ResultsBetween 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI‐CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1‐ and 12‐month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI‐CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29–7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI‐CAD patients (3.0% versus 1.3%; P=0.036). Women with MI‐CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One‐ and 12‐month mortality with MINOCA and MI‐CAD was similar (1‐month: 1.1% and 1.7% [P=0.43]; 12‐month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12‐month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06).ConclusionsYoung patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI‐CAD patients.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.

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Section: Discussionmentioning

confidence: 87%

“…Finally, we observed heterogeneity in MINOCA management, exposing a gap that needs attention 36. We noted variation in the revascularization strategy in SCAD patients regardless of the degree of stenosis and little use of proven therapies such calcium channel blockers in patients with angiographically demonstrable vasospasm 53.…”

Section: Discussionmentioning

confidence: 93%

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

Safdar

Spatz

Dreyer

et al. 2018

JAHA

Self Cite

331

233

View full text Add to dashboard Cite

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“…Myocardial infarction is often associated with occlusive coronary artery disease (CAD) but myocardial infarctions in presence of non-obstructed coronary arteries have been reported to be as high as 6%. 9 Coronary artery spasm is attributed to be a major cause for the acute coronary syndrome (ACS) associated with non-obstructed coronary arteries. 9 In 1991, Dr. Nicholas Kounis defined Kounis syndrome [KS] as the occurrence of acute coronary syndrome in the presence of an allergic reaction.…”

Section: Discussionmentioning

confidence: 99%

“…9 Coronary artery spasm is attributed to be a major cause for the acute coronary syndrome (ACS) associated with non-obstructed coronary arteries. 9 In 1991, Dr. Nicholas Kounis defined Kounis syndrome [KS] as the occurrence of acute coronary syndrome in the presence of an allergic reaction. 10 KS has three types: (i) Vasospastic allergic angina-ACS in patients with no underlying CAD, (ii) Allergic myocardial infarction-ASC in patients with underlying CAD and (iii) Stent thrombosis with occluding thrombus infiltrated by eosinophils-ACS in patients with established coronary thrombus and stenting.…”

Section: Discussionmentioning

confidence: 99%

Kounis Syndrome: A simple MRI with contrast turned into a life threatening condition

Amro¹,

Mansoor²,

Amro³

et al. 2019

Marshall Journal of Medicine

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Kounis syndrome (KS) is a hypersensitivity coronary disorder induced by various allergens. It is a rare condition which has been reported in every age group (2-90 years) and in every race and geographic location. Its incidence has been reported to range from 7.9 to 19.4 per 100,000. The presentation of the detrimental effects of KS on coronary arteries ranges from vasospastic angina to allergic myocardial infarction. Drugs are the major iatrogenic cause of KS, but virtually everything in the environment around us can cause KS. In recent years contrast mediums used in the radiologic investigation have come forth as a leading cause of anaphylaxis. Gadolinium is a rare earth metal that is used in contrast mediums for magnetic resonance imaging and is generally considered to be safe. This is a case of 52-year-old female who developed KS after receiving gadobenate dimeglumine, a gadolinium based contrast medium (GBCM) for MRI of the brain as a work up for metastatic renal cell carcinoma. Her EKG was remarkable for ST elevations in the inferior leads. Cardiac catheterization was preformed which did not reveal any significant obstructive coronary artery disease. Patient was treated with anti-histamines, corticosteroids and norepinephrine after which she recovered and discharged home stable. GBCM induced KS is very rare and to our knowledge this is the third case of Kounis syndrome reported in association with gadobenate dimeglumine.

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“…Abnormal contraction of vessels, termed ‘vasospasm’, results in tissue ischaemia and necrosis and plays a key role in the development of cardiovascular diseases. Functional disorders of coronary circulation lead to coronary artery vasospasm (vasospastic angina) that contributes to the development of myocardial ischaemia and myocardial infarction . Cigarette smoking strongly increases the risk of the development of peripheral arterial disease, coronary heart disease and stroke .…”

mentioning

confidence: 99%

Lipid‐soluble Cigarette Smoke Particles Induced Vascular Endothelin Type A Receptor Up‐Regulation through Activation of ERK1/2 Signal Pathways

Zhang

Edvinsson

et al. 2017

Basic Clin Pharma Tox

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Abnormal contraction of vessels termed 'vasospasm' is associated with various cardiovascular diseases. Smoking is a well-known risk factor that increases vasospasm. However, the molecular mechanisms by which smoking leads to vasospasm and cardiovascular disease are not fully understood. This study was designed to examine whether DMSO-extracted cigarette smoke particles (DSP) could induce up-regulation of vascular endothelin type A (ET ) receptors, and whether ET receptor is up-regulated through activation of extracellular regulated protein kinases 1 and 2 (ERK1/2) signal pathways. Mesenteric arterial segments from rats were cultured in the presence of DSP, water-extracted cigarette smoke particles (WSP) or equivalent concentration of nicotine for up to 24 hr. The results showed that DSP, but not WSP or nicotine, induced ET receptor up-regulation with increased ET receptor-mediated contraction (myograph, p < 0.001). Simultaneously, the expression of ET receptor mRNA (real-time PCR, p < 0.001) and protein (immunohistochemistry) were enhanced in the smooth muscle cells, suggesting that the lipid-soluble substances contained in cigarette smoke were responsible for the effects of DSP. Actinomycin D (a general transcriptional inhibitor) decreased ET receptor mRNA expression and attenuated receptor-mediated contraction (p < 0.001), while DSP accelerated ET receptor mRNA degradation (p < 0.01) and promoted the translation of ET receptor mRNA into protein. Furthermore, the up-regulation of ET receptors was significantly attenuated by inhibition of ERK1/2 signal pathways (p < 0.001). In conclusion, DSP most likely activate ERK1/2 signal pathway-mediated transcriptional and post-transcriptional (translational) mechanisms that lead to vascular ET receptor up-regulation, which might contribute to vasospasm and the development of smoking-associated cardiovascular diseases.

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The importance of evaluating patients with MINOCA (myocardial infarction with non-obstructive coronary arteries)

Cited by 15 publications

References 10 publications

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

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

Kounis Syndrome: A simple MRI with contrast turned into a life threatening condition

Lipid‐soluble Cigarette Smoke Particles Induced Vascular Endothelin Type A Receptor Up‐Regulation through Activation of ERK1/2 Signal Pathways

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