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,International Journal of Cardiology

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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
International Journal of Cardiology ( IF 3.2 ) Pub Date : 2021-12-03 , DOI: 10.1016/j.ijcard.2021.11.088
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 ₁

Affiliation

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.

中文翻译：

通过心血管磁共振成像评估的心肌梗死无阻塞冠状动脉 (MINOCA) 工作诊断患者的长期临床结果

背景

非阻塞性冠状动脉心肌梗死 (MINOCA) 是肌钙蛋白阳性急性胸痛患者中的一个独特实体。我们之前曾报道过该队列中心血管磁共振 (CMR) 的增量诊断能力。根据急性 CMR 诊断对这些患者的长期（> 5 年）临床结果进行分级的证据很少。

方法和结果

前瞻性研究了 229 名在急性入院期间（2010-2017 年）接受 CMR 评估的 MINOCA 工作诊断患者。主要终点是主要不良心脏事件（MACE），定义为全因死亡率和心血管再入院的复合，从医院和初级保健记录中确定。在就诊后中位 6 天（IQR 2、8）进行的 CMR 为 85% 的患者（38% 的心肌炎、28% 的急性心肌梗死和 19% 的 Takotsubo 心肌病）提供了诊断。在 7.1 年的中位随访（IQR 3.7、8.2）中，56 名（24%）患者经历了 MACE。我们发现 CMR 诊断与 MACE 之间存在强关联（对数秩 30.47，p < 0.001)。在多变量分析中，年龄（风险比 = 1.07；95% 置信区间 = 1.05、1.10；p < 0.001）和 CMR 诊断急性心肌梗死（风险比 = 8.87；95% 置信区间 = 2.58、30.4；p = 0.001）是 MACE 的独立预测因子。