Giulia Magnani1, Serena Bricoli2, Maddalena Ardissino3, Giuseppe Maglietta4, Adam Nelson5, Guidantonio Malagoli Tagliazucchi6, Caterina Disisto2, Patrizia Celli7, Maurizio Ferrario8, Umberto Canosi9, Carlo Cernetti10, Francesco Negri11, Piera Angelica Merlini12, Marco Tubaro13, Carlo Berzuini14, Chiara Manzalini2, Gianfranco Ignone15, Carlo Campana16, Luigi Moschini17, Elisabetta Ponte18, Roberto Pozzi19, Raffaela Fetiveau20, Silvia Buratti2, Elvezia Paraboschi21, Rosanna Asselta21, Andrea Botti2, Domenico Tuttolomondo2, Federico Barocelli2, Andrea Biagi2, Rosario Bonura2, Tiziano Moccetti22, Antonio Crocamo2, Giorgio Benatti2, Giorgia Paoli2, Emilia Solinas2, Maria Francesca Notarangelo2, Elisabetta Moscarella23, Paolo Calabrò23, Stefano Duga21, Giampaolo Niccoli2, Diego Ardissino24. 1. Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. Electronic address: magnanigi@ao.pr.it. 2. Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. 3. Imperial College London, London, UK. 4. Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy. 5. Duke Clinical Research Institute, Durham, NC, USA; South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia. 6. UCL Genetics Institute, Department of Genetics, Evolution and Environment. University College, London, UK. 7. Division of Cardiology, Ospedale San Camillo, Rome, Italy. 8. Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy. 9. Division of Cardiology, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy. 10. Cardio-neurovascular Department, Cà Foncello and San Giacomo Hospital Azienda No. 2, Marca Trevigiana Treviso, Treviso, Italy. 11. Cardiothoracic Department, University Hospital "Santa Maria della Miserciordia", Udine, Italy. 12. Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy; Division of Cardiology, Azienda Ospedaliera, Ospedale Niguarda Cà Granda, Milan, Italy. 13. ICCU, Intensive and Interventional Cardiology, San Filippo Neri Hospital, Rome, Italy. 14. Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK. 15. Department of Cardiology, Antonio Perrino Hospital, Azienda Sanitaria Locale di Brindisi, Brindisi, Italy. 16. Department of Cardiology, Sant'Anna Hospital, Como, Italy. 17. Unità Operativa Cardiologia e UTIC, Cremona, Italy. 18. Servizio di Radiologia, Hospital Universitario de Toledo, Spain. 19. Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy. 20. Division of Cardiology, Ospedale di Legnano, Legnano, Italy. 21. Department of Biomedical Sciences, Humanitas University, and Humanitas Clinical and Research Center IRCCS, Milan, Italy. 22. Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland. 23. University Division of Clinical Cardiology, AORN Sant'Anna e San Sebastiano, Caserta, and Department of Translational Medical Sciences, Luigi Vanvitelli University of Campania, Naples, Italy. 24. Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Associazione per lo Studio della Trombosi in Cardiologia, Pavia, Italy.
Abstract
BACKGROUND: Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS: The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS: MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS: MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
BACKGROUND: Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS: The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS: MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS: MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
Authors: Pablo Juan-Salvadores; Víctor Alfonso Jiménez Díaz; Ana Rodríguez González de Araujo; Cristina Iglesia Carreño; Alba Guitián González; Cesar Veiga Garcia; José Antonio Baz Alonso; Francisco Caamaño Isorna; Andrés Iñiguez Romo Journal: J Interv Cardiol Date: 2022-07-30 Impact factor: 1.776