SPC365

MINOCA – not a definitive diagnosis

Session: Posters (Sessão 6 - Écran 3) - MINOCA
Speaker: Marta Miguez Vilela

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: Marta Miguez De Freitas Vilela; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Catarina Gregório; Miguel Azaredo Raposo; Ana Abrantes; João Santos Fonseca; Joana Rigueira; Rui Plácido; Fausto J. Pinto; Ana G. Almeida

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity characterized by clinical evidence of MI in the absence of coronary artery stenosis &ge;50% on angiography. There are multiple pathophysiological mechanisms, so it should be considered a working diagnosis until a thorough investigation about the underlying cause is completed. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#131413">Despite the increased risk of major cardiovascular (CV) events in MINOCA patients (pts), many are discharged without a definitive diagnosis.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Objective: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">To analyse the diagnostic workflow and treatment strategy of MINOCA pts.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">We conducted a retrospective analysis of MINOCA pts admitted in a tertiary hospital and who have performed cardiac magnetic resonance imaging (CMR) in this context.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">We enrolled 36 pts (mean age 67</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#ffffff">-</span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">years, &plusmn; 14; 64% female) in our casuistic. The predominant clinical presentation was chest pain (83%). Coronarography angiography showed mild coronary stenosis in 14% of pts. Intracoronary evaluation was done in only one patient. Echocardiography performed during the hospital admission period showed a median ejection fraction of 58% and wall motion abnormalities (WMA) were found in half of the pts. CMR was performed with a median time of 28 days from presentation - 58% had late gadolinium enhancement, 55% WMA and 24% myocardial oedema. It was able to differentiate myocardial injury related to ischaemic events (31%), myocarditis (11%) and Takotsubo syndrome (2%) in 58% of pts. In 12 pts CMR did not show any alteration and no definitive diagnosis was reached (3 had end-stage chronic kidney disease).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Of note, none of these pts have done transoesophageal echocardiography and thrombophilia disorders were not assessed.&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">At time of discharge, anti-thrombotic and anticoagulation (AC) therapy schemes were single antiplatelet therapy (31%), dual antiplatelet therapy (22%) and oral AC (19%). Most pts were on statin therapy (94%) and about one third medicated with calcium channel blockers (31 %).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Median follow-up (FUP) time was 14 months. During FUP 1 patient had a CV event (stroke) and 2 pts died from CV cause.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial"><span style="color:#000000">Our casuistic emphasizes the importance of MINOCA underlying aetiology investigation. CMR is central in this context, since it can provide MI diagnosis confirmation and identify other potential causes. However, some pts had a normal CMR and complementary study has to be done in order to improve treatment strategy and pts prognosis</span></span></span></p>