SPC365

Study of the prevalence, prognosis and mortality of patients diagnosed with MINOCA

Session: Posters (Sessão 6 - Écran 3) - MINOCA
Speaker: Inês Macedo Conde

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: Inês Macedo Conde; Carla Marques-Pires; Paulo Medeiros; Rui Flores; Fernando Mané; Rodrigo Silva; Mónica Dias; Ana Sofia Fernandes; Cátia Oliveira; Carlos Braga; Catarina Quina-Rodrigues; Jorge Marques

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">INTRODUCTION:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">It&rsquo;s increasingly recognized that there is a group of patients with acute myocardial infarction (AMI) without evident obstructive coronary artery disease (CAD) on coronary angiography (stenosis &ge; 50% in an epicardial artery), currently being designated as acute myocardial infarction without obstructive coronary disease (MINOCA).&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">GOALS:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">To characterize the group of patients diagnosed with MINOCA, with regard to its prevalence and clinical, laboratory, echocardiographic, imaging and prognostic variables. To study the diagnostic profitability of cardiac magnetic resonance (CMR). Lastly, to compare the mortality in the MINOCA group with that of a group of patients admitted for AMI without ST-segment elevation.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">METHODS:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective, observational and analytical study that included 516 patients, admitted for AMI, without ST-segment elevation on the electrocardiogram and without significant CAD on coronary angiography between January 2016 and September 2021.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">RESULTS:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">After applying the inclusion criteria, 163 patients remained of the 516 admitted to the study, who were later divided into 4 groups based on the CMR results: MINOCA (n=51; MRI showing myocardial edema or transmural or subendocardial late-gadolinium enhancement), Takotsubo syndrome (n=37), myocarditis (n=33) and without diagnosis (n=42, normal MRI).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding the patients classified as MINOCA, the majority were female (52,9%), with a mean age of 61.06 &plusmn; 13.83 years. The most prevalent symptom on admission was chest pain in (49, 96.1%). Half of the patients had arterial hypertension and more than half (58.8%) had dyslipidemia.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CMR established a diagnosis in 74.2% of patients admitted for suspected acute MI in which coronary angiography showed the absence of significant obstructions. The median time between hospital admission and CMR was significantly shorter in the groups that had a diagnostic findings on the CMR compared to the group with no diagnosis (p=0.038), with a significant increase in diagnostic profitability if the CMR was performed up to 14 days after admission (p=0.022).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">When comparing our group&rsquo;s mortality with that of a group of patients admitted for AMI without ST-segment elevation, in order to ensure an even distribution of confounders between groups and therefore increase between group comparability, propensity score matching was performed. In the MINOCA group there were no deaths of cardiovascular etiology reported during the hospitalization nor during the follow-up period (one year follow-up). In the matched AMI group, the mortality rate during hospitalization was 7,4% and during the follow-up period was 11,1%.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CONCLUSION:</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In this population, the diagnosis of MINOCA is associated with a good prognosis. CMR plays a key role in the diagnostic approach of these patients, as it establishes the diagnosis in 3 out of 4 patients and should be performed within the first 14 days after admission.</span></span></span></p>