Rachel P Dreyer1,2, Rosanna Tavella3,4,5, Jeptha P Curtis1,6, Yongfei Wang1,6, Sivabaskari Pauspathy3,4,5, John Messenger7, John S Rumsfeld7, Thomas M Maddox8, Harlan M Krumholz1,6,9, John A Spertus10, John F Beltrame3,4,5. 1. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, Connecticut, USA. 2. Department of Emergency, Yale School of Medicine, 464 Congress Ave, Suite 260, New Haven, Connecticut, 06510, USA. 3. The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, 28 Woodville Road, Woodville South, 5011, South Australia. 4. Basil Hetzel Institute for Translational Research, 37 Woodville Road, Woodville South, 5011, South Australia. 5. Cardiology Department, Central Adelaide Local Health Network, 28 Woodville Road, Woodville South, 5011, South Australia. 6. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 330 Cedar St, New Haven, 06520-8056, Connecticut, USA. 7. Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, Colorado, 80045, USA. 8. Division of Cardiology, Washington University School of Medicine; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine; 660 S Euclid Ave, St Louis, Missouri, 63110, USA. 9. Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06510, Connecticut, USA. 10. Health Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, Missouri, 64111, USA.
Abstract
AIMS: The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). METHODS AND RESULTS: Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with ≥50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P < 0.001), but was similar between MINOCA and MICAD patients for re-hospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. CONCLUSION: This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). METHODS AND RESULTS: Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with ≥50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P < 0.001), but was similar between MINOCA and MICAD patients for re-hospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. CONCLUSION: This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months. Published on behalf of the European Society of Cardiology. All rights reserved.
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