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MINOCA patients presenting with ST segment elevation: look beyond the catchy name.
Session:
Painel 7 -Doença Coronária 2
Speaker:
Ana Neto
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.14 Cardiovascular Disease in Special Populations - Other
Session Type:
Posters
FP Number:
---
Authors:
Ana Leal Neto; Inês Pereira Oliveira; Isabel Martins Da Cruz; Daniel Seabra De Carvalho; Rui Pontes dos Santos; Aurora Andrade; Paula Pinto
Abstract
<p><strong>Introduction:</strong><strong> </strong>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome characterized by clinical evidence of myocardial infarction with normal or near-normal coronary arteries. It represents a conundrum given the various underlying aetiologies and pathogenic mechanisms related with this syndrome, presenting different patterns in electrocardiogram (ECG).</p> <p><strong>Purpose:</strong> Evaluate a cohort of pts with MINOCA diagnosis who underwent cardiac magnetic ressonance (CMR) and identify relevant clinical differences in pts presenting with ST segment elevation.</p> <p><strong>Methods:</strong> Unicentric, retrospective analysis of pts admitted with MINOCA who underwent CMR between 1/2013 and 9/2019. Clinical, analytical, ECG, imagiological features and follow-up - cardiovascular (CV) events and mortality - were analysed. Pts were divided according to the initial ECG presentation: ST segment elevation (G1) and non-ST segment elevation (G2). </p> <p><strong>Results: </strong>Out of the 781 CMR studies evaluated, 196 pts had the initial diagnosis of MINOCA (25.1%). Mean age was 47.4±17.2 years (y) with female predominance (58.2%, p=0.022). G1 had 75 pts (38.3%) and were younger (41.6±17.2 vs G2 51.1±16.2y, p<0.001). There were no significant differences regarding cardiovascular risk factors nor previous medication or CMR features, except for the presence of late gadolinium enhancement (LGE) which was more prevalent in G1 pts (74.0% vs G2 52.1%, p=0.003). Regarding definitive diagnosis, there was a lower prevalence of myocarditis diagnosis in G2 pts (60.0% vs G2 31.4%, p<0.001) and Takotsubo syndrome diagnosis in G1 pts (4.0% vs G2 12.4%, p=0.048). G2 pts presented more frequently with T wave inversion (24.0% vs G2 45.5%, p=0.003). As for discharge medication, G2 had higher prescription of aspirin (25.3 vs G2 52.1%, p<0.001), P2Y12 inhibitors (20.0 vs G2 34.7%, p=0.028) and statins (34.7 vs G2 66.1%, p<0.001). There were no significant differences regarding CV events nor mortality.</p> <p><strong>Conclusion:</strong><strong> </strong>In our cohort, pts presenting with ST segment elevation were younger, had higher prevalence of LGE on CMR and higher prevalence of myocarditis as definitive diagnosis. G2 had more frequently Takotsubo syndrome diagnosis and presented more with T wave inversion. On the other hand, pts with non-ST segment elevation presentation had more antiplatelet therapy and statins at discharge. No differences were found regarding CV events nor mortality.</p>
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