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. 2022 Feb 15:349:12-17.
doi: 10.1016/j.ijcard.2021.11.088. Epub 2021 Dec 3.

Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging

Rajiv Ananthakrishna  1 , Zach Liang  2 , Betty Raman  3 , John L Moran  4 , Benita Rajvi  5 , Sanjana Patil  5 , Suchi Grover  6 , Cameron Bridgman  6 , Joseph B Selvanayagam  7
Affiliations

Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging

Rajiv Ananthakrishna et al. Int J Cardiol. .

Abstract

Background: Myocardial infarction with non-obstructed coronary arteries (MINOCA) is a distinct entity among patients presenting with troponin-positive acute chest pain. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. There is paucity of evidence on the long-term (> 5 years) clinical outcomes of these patients as graded by their acute CMR diagnosis.

Methods and results: A total of 229 patients with a working diagnosis of MINOCA who underwent CMR assessment during the acute admission (2010-2017) were prospectively studied. The primary endpoint was major adverse cardiac events (MACE) defined as a composite of all-cause mortality and cardiovascular readmissions, identified from hospital and primary care records. CMR performed at a median of 6 days (IQR 2, 8) from presentation provided a diagnosis in 85% of the patients (38% myocarditis, 28% acute myocardial infarction and 19% Takotsubo cardiomyopathy). Over a median follow-up of 7.1 years (IQR 3.7, 8.2), 56 (24%) patients experienced a MACE. We found a strong association between CMR diagnosis and MACE (log rank 30.47, p < 0.001). In multivariate analysis, age (hazard ratio = 1.07; 95% confidence interval = 1.05, 1.10; p < 0.001) and CMR diagnosis of acute myocardial infarction (hazard ratio = 8.87; 95% confidence interval = 2.58, 30.4; p = 0.001) were independent predictors of MACE.

Conclusions: In a large cohort of patients with a working diagnosis of MINOCA, one in four suffer a MACE during long-term clinical follow-up. CMR diagnosis of acute myocardial infarction and age were significant predictors of MACE even in the absence of significant coronary artery obstruction.

Keywords: Acute myocardial infarction; Cardiovascular magnetic resonance; Clinical outcomes; MINOCA; Myocarditis; Takotsubo cardiomyopathy.

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Comment in

  • "MINOCA" the Pandora's box.
    Sammut E, Singhal A, Dastidar AG. Sammut E, et al. Int J Cardiol. 2022 Apr 15;353:1-2. doi: 10.1016/j.ijcard.2022.01.010. Epub 2022 Jan 7. Int J Cardiol. 2022. PMID: 34999185 No abstract available.

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