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Do Cardiovascular Risk Factors impact the management of Myocardial Infarction with No Obstructive Coronary Atherosclerosis patients?
Session:
Posters (Sessão 6 - Écran 3) - MINOCA
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 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 whether CVRF implies differences in the presentation, cardiac examinations or treatment of patients with MINOCA.</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. Patients were divided in two groups for comparison: CVRF vs healthy. We considered CVRF patients those with history of any of the following: hypertension, diabetes <em>mellitus</em>, dyslipidemia, obesity or smoking.</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>In a cohort of 76 patients, almost half (48.7%) revealed at least one CVRF. CVRF patients were older (60 ± 5 vs 41 ± 7 years-old) and mainly men (59,5%). The most prevalent CVRF was hypertension (36.8%), followed by active or past smoking history (29.6%), dyslipidemia (28.9%), obesity (22.4%) and type-2 diabetes <em>mellitus</em> (12,5%). Surprisingly, healthy patients denoted more often (25.6 vs 13.5%) ST-segment elevation mimicking ST-elevation myocardial infarction (STEMI) on ECG, although CVRF were associated with segmental wall-motion abnormalities (64.9 vs 23%, p<0.001) on echocardiogram. Analyzing cardiac enzymes, healthy patients showed higher elevation of high-sensitivity troponin I (14923 ± 11741 vs 1695 ± 1330 ng/L) but lower value of B-type natriuretic peptide (BNP) (131 ± 79 vs 350 ± 195 pg/mL). Interestingly, healthy patients demonstrated fewer normal reports on CMR (32.4 vs 15.4%). Healthy patients were associated with late gadolinium enhancement (LGE) (69.2 vs 37.8%; p=0.01) and myocardial edema (51.3 vs 27%; p=0.045) on CMR. We also found that CVRF patients were associated with a higher probability of establishing the cause of MINOCA by CMR (37.8 vs 10.3%; p=0.005). </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, the absence of CVRF was associated with LGE and myocardial edema on CMR, and also revealed a lower probability of establishing the cause of MINOCA. This study raises the question if CRVF represent a different phenotype on presentation, cardiac examinations and treatment of MINOCA patients.</span></span></p>
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