Kevin R Bainey1, Robert C Welsh2, Wendimagegn Alemayehu3, Cynthia M Westerhout3, Dean Traboulsi4, Todd Anderson4, Neil Brass5, Paul W Armstrong2, Padma Kaul2. 1. Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: kevin.bainey@albertahealthservices.ca. 2. Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. 3. Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. 4. Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada. 5. CK Hui Heart Centre, University of Alberta, Edmonton, Alberta, Canada.
Abstract
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a known clinical conundrum with limited investigation. Using a large population-based cohort, we examined the incidence, demographic profile, use of evidence-based medicines (EBM) and clinical outcomes of MINOCA patients. METHODS: Patients hospitalized with a primary diagnosis of MI who underwent coronary angiography between 01/04/2002 and 31/03/2014 in Alberta, Canada, were included in the study. Comparisons were made between patients with MINOCA versus obstructive coronary disease (OCD). The primary composite endpoint was 1-year all-cause death or re-MI. RESULTS: Of 35,928 patients hospitalized with MI, 2092 (5.8%) had MINOCA. In-hospital mortality rate was 0.8% among MINOCA, and 2.7% among patients with OCD (p < 0.0001). At 6 months, cardiovascular EBM rates were significantly lower among MINOCA patients compared to OCD patients. One-year death/re-MI rate was 5.3% in MINOCA and 8.9% in patients with OCD (adjusted hazard ratio (AHR) 0.75, 95% confidence interval (CI) 0.62-0.92, p < 0.0001). Five-year mortality rates were 10.9% in MINOCA and 16.0% in patients with OCD. Upon further stratification, 770 (36.8%) of MINOCA patients had no angiographic evidence of CAD (i.e. normal angiograms). EBM rates were even lower among these patients. One-year death/re-MI rate among these patients was 3.9% as compared to 6.1% among MINOCA patients with stenosis <50% (AHR 0.68, 95% CI 0.44-1.07, p = 0.028). CONCLUSIONS: The population-level incidence of MINOCA is approximately 5%. Despite their apparently benign anatomic findings, efforts must be made to improve secondary prevention strategies to reduce the burden of long-term adverse outcomes in this population.
BACKGROUND:Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a known clinical conundrum with limited investigation. Using a large population-based cohort, we examined the incidence, demographic profile, use of evidence-based medicines (EBM) and clinical outcomes of MINOCA patients. METHODS:Patients hospitalized with a primary diagnosis of MI who underwent coronary angiography between 01/04/2002 and 31/03/2014 in Alberta, Canada, were included in the study. Comparisons were made between patients with MINOCA versus obstructive coronary disease (OCD). The primary composite endpoint was 1-year all-cause death or re-MI. RESULTS: Of 35,928 patients hospitalized with MI, 2092 (5.8%) had MINOCA. In-hospital mortality rate was 0.8% among MINOCA, and 2.7% among patients with OCD (p < 0.0001). At 6 months, cardiovascular EBM rates were significantly lower among MINOCA patients compared to OCDpatients. One-year death/re-MI rate was 5.3% in MINOCA and 8.9% in patients with OCD (adjusted hazard ratio (AHR) 0.75, 95% confidence interval (CI) 0.62-0.92, p < 0.0001). Five-year mortality rates were 10.9% in MINOCA and 16.0% in patients with OCD. Upon further stratification, 770 (36.8%) of MINOCA patients had no angiographic evidence of CAD (i.e. normal angiograms). EBM rates were even lower among these patients. One-year death/re-MI rate among these patients was 3.9% as compared to 6.1% among MINOCA patients with stenosis <50% (AHR 0.68, 95% CI 0.44-1.07, p = 0.028). CONCLUSIONS: The population-level incidence of MINOCA is approximately 5%. Despite their apparently benign anatomic findings, efforts must be made to improve secondary prevention strategies to reduce the burden of long-term adverse outcomes in this population.
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Rachel P Dreyer; Rosanna Tavella; Jeptha P Curtis; Yongfei Wang; Sivabaskari Pauspathy; John Messenger; John S Rumsfeld; Thomas M Maddox; Harlan M Krumholz; John A Spertus; John F Beltrame Journal: Eur Heart J Date: 2020-02-14 Impact factor: 35.855
Authors: Anaïs Hausvater; Nathaniel R Smilowitz; Boyangzi Li; Gabriel Redel-Traub; Mary Quien; Yingzhi Qian; Judy Zhong; Joseph M Nicholson; Giovanni Camastra; Loïc Bière; Roman Panovský; Montenegro Sá; Edouard Gerbaud; Joseph B Selvanayagam; Mouaz H Al-Mallah; Tilman Emrich; Harmony R Reynolds Journal: JACC Cardiovasc Imaging Date: 2020-07-09