Author + information
- Javier Lopez Pais,
- Barbara Izquierdo,
- Victoria González,
- Juan Gorriz Magana,
- Rebeca Mata Caballero,
- María Jesús Espinosa Pascual,
- David Galán,
- Carlos Gustavo Martinez Peredo,
- Paula Awamleh and
- Joaquin Alonso Martin
Background: Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) remains a challenge in the clinical practice. The aim of this study is to analyze the incidence, clinical profile, pathophysiological mechanisms and the prognosis of MINOCA patients.
Methods: Analytical and observational study developed in a University Hospital, which covers 220.000 individuals. We analyze clinical and angiographic data of all consecutive MINOCA patients admitted to our center during a 19 months period. We used the definitions and the clinical management of 2016 ESC Working Group Position Paper on MINOCA.
Results: Forty-four of 538 patients initially admitted for acute myocardial infarction (MI) were classified as MINOCA (incidence 8.2%). Patients with MINOCA were younger (60 vs 66.3 years, p <0.05) and the proportion of women was higher (46% vs 13%, p <0.05) than the obstructive group. The MINOCA group had less cardiovascular risk factors (Diabetes 9% vs 59%, Dyslipidemia 27% vs 66%, Hypertension 46% vs 59% and tobacco 45% vs 62%). The presence of ST elevation was similar (34.4% vs 38.7%). Forty-five percent of MINOCA patients referred emotional stress while only 31.1% did the same in the other group. The most prevalent pathophysiological mechanisms of MINOCA were plaque disruption (25%) and stress myocardiopathy (25%). Other mechanisms were coronary spasm (13.6%), coronary embolus (9.1%) and coronary artery dissection (2.3%). In 11.4% of the patients we did not find the mechanism. Only 13.6% of patients initially included in the working diagnosis of MINOCA were finally diagnosed of myocarditis. There was no mortality during the admission and follow up (Median 9 months) in the MINOCA group, and only 2.3% had any mayor adverse cardiovascular events, having 15.9% rate of re-hospitalization.
Conclusions: The incidence of MINOCA in the real world is high (8% of patients initially diagnosed of MI). The prognosis of MINOCA patients is good and the clinical features are different than patients with obstructive coronary arteries. The most common mechanisms (50% of cases) were plaque disruption and stress myocardiopathy. Further studies are necessary to offer the best management possible to those patients.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-350
- 2017 American College of Cardiology Foundation