Amardeep Ghosh Dastidar1, Anna Baritussio1, Estefania De Garate2, Zsofia Drobni3, Giovanni Biglino1, Priyanka Singhal1, Elena G Milano1, Gianni D Angelini2, Stephen Dorman3, Julian Strange3, Thomas Johnson1, Chiara Bucciarelli-Ducci4. 1. Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom. 2. Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Bristol National Institute of Health Research, Biomedical Research Centre, Bristol, United Kingdom. 3. Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom. 4. Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; School of Clinical Sciences, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom; Bristol National Institute of Health Research, Biomedical Research Centre, Bristol, United Kingdom. Electronic address: c.bucciarelli-ducci@bristol.ac.uk.
Abstract
OBJECTIVES: This study sought to assess the prognostic impact of cardiac magnetic resonance (CMR) and conventional risk factors in patients with myocardial infarction with nonobstructed coronaries (MINOCA). BACKGROUND: Myocardial infarction with nonobstructed coronary arteries (MINOCA) represents a diagnostic dilemma, and the prognostic markers have not been clarified. METHODS: A total of 388 consecutive patients with MINOCA undergoing CMR assessment were identified retrospectively from a registry database and prospectively followed for a primary clinical endpoint of all-cause mortality. A 1.5-T CMR was performed using a comprehensive protocol (cines, T2-weighted, and late gadolinium enhancement sequences). Patients were grouped into 4 categories based on their CMR findings: myocardial infarction (MI) (embolic/spontaneous recanalization), myocarditis, cardiomyopathy, and normal CMR. RESULTS: CMR (performed at a median of 37 days from presentation) was able to identify the cause for the troponin rise in 74% of the patients (25% myocarditis, 25% MI, and 25% cardiomyopathy), whereas a normal CMR was identified in 26%. Over a median follow-up of 1,262 days (3.5 years), 5.7% patients died. The cardiomyopathy group had the worst prognosis (mortality 15%; log-rank test: 19.9; p < 0.001), MI had 4% mortality, and 2% in both myocarditis and normal CMR. In a multivariable Cox regression model (including clinical and CMR parameters), CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation electrocardiogram (ECG) remained the only 2 significant predictors of mortality. Using presentation with ECG ST-segment elevation and CMR diagnosis of cardiomyopathy as risk markers, the mortality risk rates were 2%, 11%, and 21% for presence of 0, 1, and 2 factors, respectively (p < 0.0001). CONCLUSIONS: In a large cohort of patients with MINOCA, CMR (median 37 days from presentation) identified a final diagnosis in 74% of patients. Cardiomyopathy had the highest mortality, followed by MI. The strongest predictors of mortality were a CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation ECG.
OBJECTIVES: This study sought to assess the prognostic impact of cardiac magnetic resonance (CMR) and conventional risk factors in patients with myocardial infarction with nonobstructed coronaries (MINOCA). BACKGROUND: Myocardial infarction with nonobstructed coronary arteries (MINOCA) represents a diagnostic dilemma, and the prognostic markers have not been clarified. METHODS: A total of 388 consecutive patients with MINOCA undergoing CMR assessment were identified retrospectively from a registry database and prospectively followed for a primary clinical endpoint of all-cause mortality. A 1.5-T CMR was performed using a comprehensive protocol (cines, T2-weighted, and late gadolinium enhancement sequences). Patients were grouped into 4 categories based on their CMR findings: myocardial infarction (MI) (embolic/spontaneous recanalization), myocarditis, cardiomyopathy, and normal CMR. RESULTS: CMR (performed at a median of 37 days from presentation) was able to identify the cause for the troponin rise in 74% of the patients (25% myocarditis, 25% MI, and 25% cardiomyopathy), whereas a normal CMR was identified in 26%. Over a median follow-up of 1,262 days (3.5 years), 5.7% patients died. The cardiomyopathy group had the worst prognosis (mortality 15%; log-rank test: 19.9; p < 0.001), MI had 4% mortality, and 2% in both myocarditis and normal CMR. In a multivariable Cox regression model (including clinical and CMR parameters), CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation electrocardiogram (ECG) remained the only 2 significant predictors of mortality. Using presentation with ECG ST-segment elevation and CMR diagnosis of cardiomyopathy as risk markers, the mortality risk rates were 2%, 11%, and 21% for presence of 0, 1, and 2 factors, respectively (p < 0.0001). CONCLUSIONS: In a large cohort of patients with MINOCA, CMR (median 37 days from presentation) identified a final diagnosis in 74% of patients. Cardiomyopathy had the highest mortality, followed by MI. The strongest predictors of mortality were a CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation ECG.
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Authors: Sophie Paddock; Vasiliki Tsampasian; Hosamadin Assadi; Bruno Calife Mota; Andrew J Swift; Amrit Chowdhary; Peter Swoboda; Eylem Levelt; Eva Sammut; Amardeep Dastidar; Jordi Broncano Cabrero; Javier Royuela Del Val; Paul Malcolm; Julia Sun; Alisdair Ryding; Chris Sawh; Richard Greenwood; David Hewson; Vassilios Vassiliou; Pankaj Garg Journal: Front Cardiovasc Med Date: 2021-07-07