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Can we predict which Myocardial Infarction with No Obstructive Coronary Atherosclerosis patients will remain with unexplained cause?
Session:
Posters (Sessão 3 - Écran 2) - Enfarte Agudo do Miocárdio 2
Speaker:
André Cabrita
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
André Cabrita; Catarina Marques; Miguel Carvalho; Mariana Vasconcelos; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Myocardial Infarction with No Obstructive Coronary Atherosclerosis (MINOCA) is a syndrome that requires evidence of myocardial infarction (MI) with normal or near normal coronary arteries on angiography. MINOCA is typical of younger patients, mostly women, with less cardiovascular risk factors (CVRF).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To determine if patients with a diagnosis of MINOCA have specific characteristics in epidemiology, comorbidities and abnormalities on cardiac examinations that can predict if they will remain with unexplained cause.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We developed a prospective 6-year study, consisting of consultation of medical records of all patients admitted in the Cardiology Department of our institution due to a diagnosis of MINOCA. These patients were later submitted to a cardiac magnetic resonance (CMR) to establish the cause of MINOCA. We divided the patients in 2 groups for comparison: MINOCA with established cause (MEC) vs idiopathic MINOCA (IM). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Our cohort consisted of 76 patients admitted with a diagnosis of MINOCA, but only 58 (76.3%) established its cause after a CMR. The most prevalent causes identified were myocarditis (38,2%), Takotsubo syndrome (13.2%) and coronary artery spasm (6.6%). 18 (23.7%) MINOCA patients remained with unexplained cause (IM). IM patients were older (63 ± 6 vs 47 ± 6 years-old), most commonly male (65.8%) and demonstrated a significantly higher prevalence of CVRF, such as type 2-diabetes <em>mellitus</em> (p=0.03), dyslipidemia (p<0.001) and obesity (p=0.02). IM patients revealed lower cardiac analytic levels, such as high-sensitivity troponin I (3280 ± 2503 vs 9369 ± 7523 ng/L) and B-type natriuretic peptide (BNP) (173 ± 148 vs 280 ± 149 pg/mL). IM was linked to higher prevalence of ventricle repolarization abnormalities on ECG (50% vs 39.7%) and segmental wall-motion abnormalities (61.1 vs 37.9%) on echocardiogram. IM patients were associated with absence of late gadolinium enhancement (LGE) (p<0.001) and myocardial edema (p=0.016) on CMR and the majority revealed no abnormalities on CMR (58.8%, p<0.001). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>In our cohort, IM patients were older, mostly male and had a higher prevalence of CVRF. They revealed lower cardiac enzymes and fewer abnormalities on CMR. This study stated that IM patients had a different phenotype of typical MINOCA patients.</span></span></p>
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