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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。

结论

在大量诊断为 MINOCA 的患者中,四分之一的人在长期临床随访期间患有 MACE。即使在没有明显冠状动脉阻塞的情况下,急性心肌梗死的 CMR 诊断和年龄也是 MACE 的重要预测因素。

更新日期:2022-01-13
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