Giuseppe Ciliberti1, Stefano Coiro2, Isabella Tritto2, Martina Benedetti2, Federico Guerra3, Maurizio Del Pinto4, Gherardo Finocchiaro5, Claudio Cavallini4, Alessandro Capucci3, Juan Carlos Kaski6, Giuseppe Ambrosio2. 1. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy; Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. 2. Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy. 3. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy. 4. Division of Cardiology, S. Maria della Misericordia Hospital, Perugia, Italy. 5. Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom. 6. Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, United Kingdom. Electronic address: jkaski@sgul.ac.uk.
Abstract
OBJECTIVE: To assess the characteristics and prognosis of patients with myocardial infarction and non-obstructed coronary arteries (MINOCA). METHODS: MINOCA was defined as acute myocardial infarction (AMI) with angiographic coronary stenosis <50%.Cardiomyopathies and myocarditis were - a priori - excluded from the study. Stenoses <30% were considered normal coronary arteries (NCA); stenoses ≥30% but <50% were considered mild coronary artery disease (MCAD). Patients were subdivided in 3 groups: I) NCA (0 vessels; stenosis <30%); II) 1-2 vessels showing MCAD and III) MCAD in 3 vessels or the left main stem (LMS). RESULTS: From January 2006 to December 2014, 7935 consecutive AMI patients were entered into our institutional database;150 (2%) were diagnosed as having MINOCA. At a median follow-up of 7.1 years the composite end-point (cardiovascular death, AMI or acute coronary syndrome, heart failure, stroke) occurred in 23 patients (17.4%). Survival analysis showed no differences between NCA versus MCAD (p = 0.781). When assessed by distribution of CAD, group III had a lower event-free survival compared to group I and group II, respectively 54 ± 14%, 83 ± 4% and 90 ± 5% (p = 0.001). In a multivariate model, only 3 vessel disease or LMS involvement (HR = 23.5, 95% CI 2.59-173.49, P = 0.001) and high C-reactive protein at hospital admission (HR = 1.47, 95% CI 1.06-2.07, P = 0.005) were significant predictors of the study composite endpoint. CONCLUSIONS: In patients with MINOCA, the presence of NCA or 1-2 vessel MCAD was associated with better long-term clinical outcomes compared with patients with MCAD affecting 3 vessels or the LMS. Increased CRP concentrations on hospital admission were also a marker of worse clinical outcome during follow-up.
OBJECTIVE: To assess the characteristics and prognosis of patients with myocardial infarction and non-obstructed coronary arteries (MINOCA). METHODS: MINOCA was defined as acute myocardial infarction (AMI) with angiographic coronary stenosis <50%.Cardiomyopathies and myocarditis were - a priori - excluded from the study. Stenoses <30% were considered normal coronary arteries (NCA); stenoses ≥30% but <50% were considered mild coronary artery disease (MCAD). Patients were subdivided in 3 groups: I) NCA (0 vessels; stenosis <30%); II) 1-2 vessels showing MCAD and III) MCAD in 3 vessels or the left main stem (LMS). RESULTS: From January 2006 to December 2014, 7935 consecutive AMI patients were entered into our institutional database;150 (2%) were diagnosed as having MINOCA. At a median follow-up of 7.1 years the composite end-point (cardiovascular death, AMI or acute coronary syndrome, heart failure, stroke) occurred in 23 patients (17.4%). Survival analysis showed no differences between NCA versus MCAD (p = 0.781). When assessed by distribution of CAD, group III had a lower event-free survival compared to group I and group II, respectively 54 ± 14%, 83 ± 4% and 90 ± 5% (p = 0.001). In a multivariate model, only 3 vessel disease or LMS involvement (HR = 23.5, 95% CI 2.59-173.49, P = 0.001) and high C-reactive protein at hospital admission (HR = 1.47, 95% CI 1.06-2.07, P = 0.005) were significant predictors of the study composite endpoint. CONCLUSIONS: In patients with MINOCA, the presence of NCA or 1-2 vessel MCAD was associated with better long-term clinical outcomes compared with patients with MCAD affecting 3 vessels or the LMS. Increased CRP concentrations on hospital admission were also a marker of worse clinical outcome during follow-up.
Authors: Piotr Szolc; Łukasz Niewiara; Paweł Kleczyński; Krzysztof Bryniarski; Elżbieta Ostrowska-Kaim; Kornelia Szkodoń; Piotr Brzychczy; Krzysztof Żmudka; Jacek Legutko; Bartłomiej Guzik Journal: J Cardiovasc Dev Dis Date: 2022-08-26
Authors: Lukasz Zandecki; Agnieszka Janion-Sadowska; Jacek Kurzawski; Lukasz Piatek; Michal Zabojszcz; Krzysztof Plens; Zbigniew Siudak; Marcin Sadowski Journal: PLoS One Date: 2020-06-16 Impact factor: 3.240
Authors: T F S Pustjens; Y Appelman; P Damman; J M Ten Berg; J W Jukema; R J de Winter; W R P Agema; M L J van der Wielen; F Arslan; S Rasoul; A W J van 't Hof Journal: Neth Heart J Date: 2020-03 Impact factor: 2.380
Authors: Kai M Eggers; Tomasz Baron; Marcus Hjort; Anna M Nordenskjöld; Per Tornvall; Bertil Lindahl Journal: Clin Cardiol Date: 2021-05-25 Impact factor: 2.882