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Title: Myocardial infarction with non-obstructive coronary arteries. The selected aspects of pathogenesis, diagnosis, treatment and the impact on long-term prognosis
Abstract:
Introduction Myocardial infarction with non-obstructive coronary arteries (MINOCA), currently defined by the lack of ≥50% stenosis in the coronary angiography, constitutes a significant percentage of patients with myocardial infarction (MI). There are conflicting data concerning long-term prognosis in MINOCA patients. Undoubtedly, MINOCA is a heterogeneous group of disease entities with often complex etiopathogenesis. According to the current guidelines, MINOCA should be considered as a working diagnosis that requires a subsequent diagnostic process. Testing for thrombophilia is one of the recommended steps. However, in the literature there is the lack of data of their full panel use in this group of patients. The issue of MINOCA chronobiology and the impact of the weekend effect has not been adequately explored yet. Oncological patients are potentially the group particularly at risk of MINOCA occurrence. However, there is a lack of data on the actual scale of this phenomenon and its prognostic significance. Objectives 1) to assess the frequency of individual thrombophilia in patients with MINOCA compared to patients with cryptogenic stroke and to analyze its clinical significance 2) to determine the MINOCA chronobiology and to analyze the impact of the weekend effect on long-term prognosis 3) to determine the clinical characteristics and long-term prognosis in oncological ; patients with MINOCA Materials and methods The full thrombophilia panel was evaluated in a prospective cross-sectional study of 84 patients with MINOCA. As controls served 84 patients with cryptogenic stroke (CS). A full panel of the most common thrombophilia was performed in all patients in accordance with the current methodology and recommendations. The assessment of the occurrence of the weekend effect was carried out in a group of 865 consecutive MI patients diagnosed who underwent coronary angiography. 642 (74.2%) were admitted on working days (WD), while 223 (25.8%) on non-working days (NWD). Of this group, 67 (7.7%) met the criteria for MINOCA diagnosis. The study endpoint was the overall long-term mortality . The group of patients with MINOCA and active cancer was selected from the cardiooncology registry of 1011 consecutive MI patients who underwent coronary angiography. Of these, 72 (7.1%) met the criteria for MINOCA diagnosis. Active cancer was identified in 134 patients (13.3%) and their oncological characteristics were determined in detail. The study endpoint was the overall long-term mortality. Results Thrombophilia was found in 23.8% of MINOCA patients and 15.5% of CS patients (P=0.17). A similar distribution of individual thrombophilia was observed in both compared groups, except for a lower frequency of elevated lipoprotein (a) levels in MINOCA (21.4 vs ; 39.3%, P=0.012). The most common inherited thrombophilia diagnosed in MINOCA patients was the factor V Leiden mutation (14.3%). In turn, APS was diagnosed in 15.5%. By comparing the obtained results with the data from the literature for the general population, it was found that all the determined thrombophilia were overrepresented in the MINOCA group. The MINOCA diagnosis was significantly more frequent in WD (9 vs 4%, P=0.019). Patients admitted on NWD and WD did not differ in terms of clinical, angiographic and laboratory characteristics. There were no in-hospital deaths in both MINOCA subgroups. In long-term follow-up, there was no difference in the overall mortality in MINOCA patients admitted on NWD and WD (22.2 vs 31%, P=0.35). The MINOCA diagnosis was also not an independent predictor of all-cause mortality in the multivariate analysis. An active cancer was significantly more frequent in patients with MINOCA than with MI and obstructive coronary artery disease (MI-CAD) (29.2 vs 12.0%, P<0.001). The long-term prognosis was significantly better in non-cancer than cancer MINOCA (HR 4.07, 95% CI 1.72–9.64, P=0.002) and in non-cancer than cancer MI-CAD (HR 7.62, 95% CI 5.13–11.31, P<0.001), respectively. A multivariate analysis showed that active cancer, lower hemoglobin values, and no MINOCA diagnosis were independent predictors of long-term mortality. In turn, multivariat ; e analysis limited to MINOCA patients identified age, active cancer and left ventricular ejection fraction as variables independently associated with long-term mortality. Conclusions 1) Patients with MINOCA are characterized by a high incidence of thrombophilia, similar to CS. 2) MINOCA is significantly more often diagnosed in WD. The diagnosis of MINOCA itself, in contrast to the MI admitted on NWD, is not independently associated with long-term overall mortality. 3) An active cancer is significantly more frequent in MINOCA than in MI-CAD patients. Its occurrence is associated with extremely high overall long-term mortality.
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Rada Dyscypliny Nauki medyczne
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Last modified:
Jul 29, 2024
In our library since:
Jun 4, 2024
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11
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http://dl.cm-uj.krakow.pl:8080/publication/5125
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| Edition name | Date |
|---|---|
| ZB-140092 | Jul 29, 2024 |
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