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. 2019 Jul 16;8(14):e011990.
doi: 10.1161/JAHA.119.011990. Epub 2019 Jul 9.

Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non-Obstructive Coronary Arteries

Eun Ho Choo  1 , Kiyuk Chang  1 , Kwan Yong Lee  1 , Dongjae Lee  1 , Jae Gyung Kim  1 , Youngkeun Ahn  2 , Young Jo Kim  3 , Shung Chull Chae  4 , Myeong Chan Cho  5 , Chong Jin Kim  6 , Hyo-Soo Kim  7 , Myung Ho Jeong  2 ; KAMIR‐NIH Investigators
Affiliations

Prognosis and Predictors of Mortality in Patients Suffering Myocardial Infarction With Non-Obstructive Coronary Arteries

Eun Ho Choo et al. J Am Heart Assoc. .

Abstract

Background Myocardial infarction with nonobstructive coronary arteries ( MINOCA ) is a heterogeneous disease entity. Its prognosis and predictor of mortality remain unclear. This study aimed to compare the prognosis between MINOCA and myocardial infarction with obstructive coronary artery disease and identify factors related to all-cause death in MINOCA using a nation-wide, multicenter, and prospective registry. Methods and Results Among 13 104 consecutive patients enrolled, patients without previous history of significant coronary artery disease who underwent coronary angiography were selected. The primary outcome was 2-year all-cause death. Secondary outcomes were cardiac death, noncardiac death, reinfarction, and repeat revascularization. Patients with MINOCA (n=396) and myocardial infarction with obstructive coronary artery disease (n=10 871) showed similar incidence of all-cause death (9.1% versus 8.8%; hazard ratio [ HR ], 1.04; 95% CI, 0.74-1.45; P=0.83). Risks of cardiac death, noncardiac death, and reinfarction were not significantly different between the 2 groups ( HR , 0.82; 95% CI , 0.53-1.28; P=0.38; HR , 1.55; 95% CI , 0.93-2.56; P=0.09; HR , 1.23; 95% CI , 0.65-2.31; P=0.38, respectively). MINOCA patients had lower incidence of repeat revascularization (1.3% versus 7.2%; HR , 0.17; 95% CI , 0.07-0.41; P<0.001). Results were consistent after multivariable regression and propensity-score matching. In a multivariate model, several significant predictors of all-cause death of MINOCA were found, including the nonuse of renin-angiotensin system blockers ( HR , 2.63; 95% CI , 1.08-6.25; P=0.033) and statins ( HR , 2.17; 95% CI , 1.04-4.54; P=0.039). Conclusions Patients with MINOCA and those with myocardial infarction with obstructive coronary artery disease had comparable clinical outcomes. Use of renin-angiotensin system blockers and statins was associated with lower mortality in patients with MINOCA .

Keywords: coronary vasospasm; myocardial infarction; prognosis; renin angiotensin system; statin.

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Figures

Figure 1
Figure 1
Study flow. The study population was derived from a nation‐wide, multicenter, prospective KAMIR‐NIH (Korea Acute Myocardial Infarction Registry‐National Institute of Health) registry. CAG indicates coronary angiography; MI, myocardial infarction; MI‐CAD, myocardial infarction with obstructive coronary artery disease; MINOCA, myocardial infarction with nonobstructive coronary arteries; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Cumulative incidence of primary and secondary outcomes. Kaplan–Meier curves with cumulative hazards of (A) all‐cause death, (B) MI, (C) death or MI, and (D) any repeat revascularization. MI indicates myocardial infarction; MI‐CAD, myocardial infarction with obstructive coronary artery disease; MINOCA, myocardial infarction with nonobstructive coronary arteries. *The primary outcome of the study.
See this image and copyright information in PMC

Comment in

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