Characterization of patients with myocardial infarction with non-obstructive coronary arteries – experience from the Croatian branch of the ISACS-CT Registry

    Authors

    DOI

    https://doi.org/10.15836/ccar2019.217

    Full Text

    Background and Aim : There are still wide knowledge gaps in myocardial infarction with non-obstructive coronary arteries (MINOCA) - a heterogeneous entity seen in 1-10% of patients with acute coronary syndrome (ACS) ( 1 ). The aim is to determine characteristics of MINOCA in the Croatian branch of the ISACS-CT registry, and compare them to age- and gender-matched patients with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Patients and Methods : The study included 2487 patients with ACS. MINOCA was defined by simultaneous cardiac troponin levels >0.014 ng/L, symptoms of ischemia or significant ST-T changes in the ECG, and an absence of coronary artery stenosis of ≥ 50% on angiography. Age and gender-matching was performed from the remaining cohort by randomly sampling patients from the UA, STEMI and NSTEMI subgroups, based on the mean age ± 5 years and the gender ratio of the MINOCA group. Results : MINOCA was seen in 2.5% (n=63) of the cohort, initially categorized as UA (37%), NSTEMI (48%) and STEMI (16%). Median age was 62 (53, 71) years, 56% male. After age- and gender-matching, there were 36 UA (10% of the UA cohort), 135 NSTEMI (15%) and 198 STEMI (16%) patients in the ACS control subgroups. MINOCA patients had a lower prevalence of diabetes, hypertension, dyslipidemia, chronic kidney disease and tobacco use as compared to UA and NSTEMI. MINOCA patients used less antiplatelets, beta-blockers and statins before hospitalization. MINOCA and STEMI subgroups had a high incidence of chest pain symptoms and a short time from symptom onset to hospitalization. In the first 24h of hospitalization, less MINOCA patients were treated with antiplatelets and statins, and at discharge, they were less frequently prescribed with antiplatelet drugs compared to UA and NSTEMI ( Table 1 ). In-hospital mortality was low, with no deaths in MINOCA and UA patients, and 2 and 3 deaths in NSTEMI and STEMI, respectively. Conclusion : MINOCA patients are mainly categorized as UA and NSTEMI at presentation, but have less comorbidities, more pronounced symptoms of typical chest pain, a shorter time from symptoms to hospitalization, lower levels of statin and antiaggregation prescription at admission, and antiaggregation at discharge. In-hospital mortality confirms MINOCA as low risk, however, long-term registry follow-up is needed to learn about longer term outcomes.

    Cardiologia Croatica
    Back to search

    Characterization of patients with myocardial infarction with non-obstructive coronary arteries – experience from the Croatian branch of the ISACS-CT Registry

    Extended Abstract
    Issue9-10
    Published
    Pages217-219
    PDF via DOIhttps://doi.org/10.15836/ccar2019.217

    Authors

    Ines Vinković*University Hospital Centre Zagreb, Zagreb, Croatia
    Filip LončarićAugust Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
    Petra MjehovićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dorja SabljakUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedrana VlahovićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Grgur SalaiUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Klara KlarićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Toni RadićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Saša PavasovićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Nina JakušUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dora FabijanovićUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivo PlanincUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Maja ČikešUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Background and Aim : There are still wide knowledge gaps in myocardial infarction with non-obstructive coronary arteries (MINOCA) - a heterogeneous entity seen in 1-10% of patients with acute coronary syndrome (ACS) ( 1 ). The aim is to determine characteristics of MINOCA in the Croatian branch of the ISACS-CT registry, and compare them to age- and gender-matched patients with unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Patients and Methods : The study included 2487 patients with ACS. MINOCA was defined by simultaneous cardiac troponin levels >0.014 ng/L, symptoms of ischemia or significant ST-T changes in the ECG, and an absence of coronary artery stenosis of ≥ 50% on angiography. Age and gender-matching was performed from the remaining cohort by randomly sampling patients from the UA, STEMI and NSTEMI subgroups, based on the mean age ± 5 years and the gender ratio of the MINOCA group. Results : MINOCA was seen in 2.5% (n=63) of the cohort, initially categorized as UA (37%), NSTEMI (48%) and STEMI (16%). Median age was 62 (53, 71) years, 56% male. After age- and gender-matching, there were 36 UA (10% of the UA cohort), 135 NSTEMI (15%) and 198 STEMI (16%) patients in the ACS control subgroups. MINOCA patients had a lower prevalence of diabetes, hypertension, dyslipidemia, chronic kidney disease and tobacco use as compared to UA and NSTEMI. MINOCA patients used less antiplatelets, beta-blockers and statins before hospitalization. MINOCA and STEMI subgroups had a high incidence of chest pain symptoms and a short time from symptom onset to hospitalization. In the first 24h of hospitalization, less MINOCA patients were treated with antiplatelets and statins, and at discharge, they were less frequently prescribed with antiplatelet drugs compared to UA and NSTEMI ( Table 1 ). In-hospital mortality was low, with no deaths in MINOCA and UA patients, and 2 and 3 deaths in NSTEMI and STEMI, respectively. Conclusion : MINOCA patients are mainly categorized as UA and NSTEMI at presentation, but have less comorbidities, more pronounced symptoms of typical chest pain, a shorter time from symptoms to hospitalization, lower levels of statin and antiaggregation prescription at admission, and antiaggregation at discharge. In-hospital mortality confirms MINOCA as low risk, however, long-term registry follow-up is needed to learn about longer term outcomes.