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Long term prognosis of pharmacological intervention in myocardial infarction with nonobstructive coronary arteries (MINOCA)
Session:
Posters (Sessão 6 - Écran 3) - MINOCA
Speaker:
Vanessa Lopes
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:
Vanessa Lopes; Nádia Moreira; Rafaela Fernandes; Gil Cunha; João Ferreira; Gonçalo Costa; Eric Monteiro; Diogo Fernandes; Joana Guimarães; James Milner; Vera Marinho; Sílvia Monteiro; Pedro Monteiro; Francisco Gonçalves; Lino Gonçalves
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Despite optimal work-up, the cause of myocardial infarction with nonobstructive coronary arteries (MINOCA) remains undetermined in 8-25% of patients with acute myocardial infarction. European Society of Cardiology (ESC) guidelines recommend that patients with a final diagnosis of MINOCA of unknown cause may be treated according to secondary prevention guidelines for atherosclerotic disease (recommendation class IIb, level of evidence C). This study sought<strong> </strong>to determine the association between pharmacological therapies after hospital discharge and the long-term prognosis of MINOCA patients.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Material and methods</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">We analyzed patients consecutively admitted to a single-center coronary care unit with MINOCA. Two groups were identified: (1) patients with MINOCA, and (2) patients with obstructive coronary artery disease (CAD). <span style="color:black">Multivariate analysis was performed to determine which drugs were implicated in the prognosis of these patients. </span>The primary endpoint was all-cause mortality at 5 years.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results </strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">From a total of 3721 myocardial infarction patients, MINOCA was identified in 11.6% (n=430), of whom 56 (13.0%) experienced the primary endpoint. Median age was 66 years (IQR 19), and 51.6% (n=222) of patients were male.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">At discharge, 81.2% of MINOCA patients were prescribed aspirin, 87.4% a statin, 78.6% beta-blockers, and 66.7% angiotensin-converting enzyme inhibitors (ACEI). MINOCA patients were less likely to be prescribed these medications compared to patients with obstructive coronary artery disease (all p <0.001). 1.4% (n=6) of MINOCA patients died in the hospital, and the 5-year mortality rate was 13.0% (n=56). In multivariate Cox regression, treatment with ACEI at discharge was found to be independently associated with a 5-year mortality benefit (HR=0.29, 95% CI 0.12-0.67, adjusted p=0.004) in MINOCA patients.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In conclusion, compared with patients with obstructive CAD, patients with MINOCA are less likely to be treated with secondary prevention drugs and are at lower risk of all-cause mortality during long-term follow-up. Treatment with ACEI seems to provide an additional mortality benefit in MINOCA patients. </span></span></p>
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