Giuseppe Ciliberti1, Monica Verdoia2, Marco Merlo3, Filippo Zilio4, Marco Vatrano5, Francesco Bianco6, Massimo Mancone7, Denise Zaffalon3, Alessia Bonci8, Andrea Boscutti3, Fabio Infusino7, Stefano Coiro9, Giulia Stronati8, Isabella Tritto9, Rocco Gioscia10, Antonio Dello Russo8, Francesco Fedele7, Sabina Gallina6, Francesco Cassadonte5, Giuseppe Ambrosio9, Roberto Bonmassari4, Giuseppe De Luca10, Gianfranco Sinagra3, Alessandro Capucci8, Juan Carlos Kaski11, Federico Guerra8. 1. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy. Electronic address: giuseppe.ciliberti@ospedaliriuniti.marche.it. 2. Ospedale degli Infermi, Biella, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy. 3. Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Italy. 4. Department of Cardiology, S. Chiara Hospital, Trento, Italy. 5. Cardiology Unit, Hospital "Pugliese-Ciaccio", Catanzaro, Italy. 6. Department of Neuroscience, Imaging and clinical Sciences, "G. d'Annunzio" University, Chieti, Italy. 7. Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy. 8. Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Ancona, Italy. 9. Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy. 10. Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy. 11. Molecular and Clinical Sciences, St George's, University of London, London, UK.
Abstract
AIMS: To assess the effect of pharmacological therapy on long-term prognosis of patients with MINOCA. METHODS AND RESULTS: In this retrospective multicentre cohort study involving 9 Hub Hospitals across Italy we enrolled consecutive patients 18 years and older with diagnosis of MINOCA discharged from 1st March 2012 to 31st March 2018. Data on baseline characteristics and pharmacological therapy at discharge (ACEI/ARB, angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists; ASA, acetylsalicylic acid; beta-blockers; CCB, calcium-channel blockers; DAPT, dual anti-platelet therapy; statins), were collected systematically. The primary endpoint (PE) of the study was a composite of all cause death or acute myocardial infarction or acute coronary syndrome or heart failure leading to hospitalization or stroke. A total of 621 patients were included (mean [SD] age 65.1 [13.9] years; 344 [55.4%] female), of whom 106 (17.1%) experienced PE, including 27 patients (4.3%) who died. Multivariable analysis, after correction for all baseline differences, showed a significant association between pharmacological therapy at discharge and an increased risk of PE for aspirin (HR[95%CI] = 2.47[1.05-5.78], adjusted p = 0.04), whereas beta-blockers were associated with a significant benefit (HR[95%CI] = 0.49 [0.31-0.79], adjusted p = 0.02). CONCLUSION: The use of beta-blockers was significantly associated to a less frequent occurrence of adverse outcomes at long-term follow-up among patients with MINOCA, whereas ASA displayed a potentially harmful impact on prognosis. The findings in the study may be relevant for the design of future studies which should take into account possible heterogeneity among MINOCA patients.
AIMS: To assess the effect of pharmacological therapy on long-term prognosis of patients with MINOCA. METHODS AND RESULTS: In this retrospective multicentre cohort study involving 9 Hub Hospitals across Italy we enrolled consecutive patients 18 years and older with diagnosis of MINOCA discharged from 1st March 2012 to 31st March 2018. Data on baseline characteristics and pharmacological therapy at discharge (ACEI/ARB, angiotensin-converting enzyme inhibitors/angiotensin receptor antagonists; ASA, acetylsalicylic acid; beta-blockers; CCB, calcium-channel blockers; DAPT, dual anti-platelet therapy; statins), were collected systematically. The primary endpoint (PE) of the study was a composite of all cause death or acute myocardial infarction or acute coronary syndrome or heart failure leading to hospitalization or stroke. A total of 621 patients were included (mean [SD] age 65.1 [13.9] years; 344 [55.4%] female), of whom 106 (17.1%) experienced PE, including 27 patients (4.3%) who died. Multivariable analysis, after correction for all baseline differences, showed a significant association between pharmacological therapy at discharge and an increased risk of PE for aspirin (HR[95%CI] = 2.47[1.05-5.78], adjusted p = 0.04), whereas beta-blockers were associated with a significant benefit (HR[95%CI] = 0.49 [0.31-0.79], adjusted p = 0.02). CONCLUSION: The use of beta-blockers was significantly associated to a less frequent occurrence of adverse outcomes at long-term follow-up among patients with MINOCA, whereas ASA displayed a potentially harmful impact on prognosis. The findings in the study may be relevant for the design of future studies which should take into account possible heterogeneity among MINOCA patients.
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: Nathaniel R Smilowitz; Rachel Dubner; Anne S Hellkamp; Robert J Widmer; Harmony R Reynolds Journal: PLoS One Date: 2021-08-02 Impact factor: 3.240