AI Article Synopsis
- Myocardial infarction with nonobstructive coronary artery (MINOCA) is a complex condition with various causes, and understanding its prognosis remains limited.
- This study used optical coherence tomography (OCT) to analyze MINOCA patients, categorizing them into atherosclerotic (Ath-MINOCA) and nonatherosclerotic (non-Ath-MINOCA) groups in order to correlate findings with clinical outcomes.
- Results showed that Ath-MINOCA patients experienced significantly worse outcomes, with a higher rate of major adverse cardiac events (15.3% vs. 4.5%) and identified atherosclerotic causes as strong predictors of these adverse events.
Article Abstract
Background: Myocardial infarction with nonobstructive coronary artery (MINOCA) is a heterogeneous syndrome caused by different pathophysiologic mechanisms. There is limited evidence regarding prognosis of patients with MINOCA caused by different mechanisms.
Objectives: The present study aimed to assess the underlying mechanisms of MINOCA by optical coherence tomography (OCT) and to correlate with clinical outcomes.
Methods: Patients with MINOCA were divided into 2 groups based on OCT findings: atherosclerotic MINOCA (Ath-MINOCA) and nonatherosclerotic MINOCA (non-Ath-MINOCA). Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal MI, target lesion revascularization, stroke, and rehospitalization for unstable or progressive angina.
Results: Among 7,423 patients with a clinical diagnosis of MI who underwent angiography, 190 of 294 MINOCA were studied using OCT. The causes of Ath-MINOCA (n = 99, 52.1%) were plaque erosion (n = 64, 33.7%), plaque rupture (n = 33, 17.4%), and calcified nodule (n = 2, 1.1%) whereas the causes of non-Ath-MINOCA (n = 91, 47.9%) were spontaneous coronary artery dissection (n = 8, 4.2%), coronary spasm (n = 9, 4.7%), and unclassified cause (n = 74, 38.9%). The 1-year MACE was 15.3% for Ath-MINOCA vs 4.5% for non-Ath-MINOCA (P = 0.015). An atherosclerotic cause was an independent predictor of MACE (HR: 5.36 [95% CI: 1.08-26.55]; P = 0.040), mainly driven by target lesion revascularization and rehospitalization, despite the composite endpoint including cardiac death and MI showing no difference.
Conclusions: OCT identified a cause in 61.1% of MINOCA, in which Ath-MINOCA represents an important and distinct MINOCA subset. Ath-MINOCA were more common and associated with worse outcomes. (Incidence Rate of Heart Failure After Acute Myocardial Infarction With Optimal Treatment; NCT03297164; Paradigm Shift in the Treatment of Patients With ACS; NCT02041650).
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jcmg.2022.10.023 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
MINOCA and Type 2 mycardial infarction: Unveiling the hidden differences.
Int J Cardiol
December 2024
Centro Cardiologico Monzino, I.R.C.C·S, Milan, Italy. Electronic address:
Pathological findings at invasive assessment in MINOCA: a systematic review and meta-analysis.
Heart
December 2024
Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Emilia-Romagna, Italy
Background: Pathological mechanisms of myocardial infarction with non-obstructive coronary arteries (MINOCA) are heterogeneous, with an unknown impact on prognosis, and often remain unrecognised in clinical practice. This study aimed to evaluate the prevalence and prognostic impact of pathological findings by invasive coronary angiography (ICA), optical coherence tomography (OCT), and coronary function testing in MINOCA.
Methods: Studies published until August 2023 were searched on PubMed and SCOPUS and included if reporting the prevalence of patients with non-obstructive coronary arteries (NObs-CA; 1-49% coronary stenosis) versus normal coronary arteries (NCA; 0% coronary stenosis) by ICA, pathological findings by OCT, and/or coronary vasomotor tests in MINOCA.
Rare Clinical Manifestation of Vasculitis.
Diagnostics (Basel)
November 2024
Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania.
Background: Antineutrophil cytoplasm antibody (ANCA)-associated vasculitis usually affects small blood vessels and is characterized by the presence of circulating autoantibodies (c-ANCA or p-ANCA). The risk of cardiovascular events is threefold higher compared to general population, and cardiac manifestations include myocarditis, pericarditis, valvulitis, aortitis, or coronary arteritis. Coronary involvement is very rare, but it is a potentially life-threatening manifestation.
View Article and Find Full Text PDFA rare complication of blood donation: MINOCA.
Am J Emerg Med
December 2024
Department of Emergence Medicine, Republic of Turkey, Ministry of Healthy Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey.
Blood donation is a life-saving process that involves the temporary loss of a specific blood volume. Although generally safe, it may lead to adverse reactions, particularly in first-time donors. Among these, severe outcomes like myocardial infarction (MI) are extremely rare.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!