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Chander Y, Duggal B, Soni S. Does the management of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) changes with advanced diagnostic workup beyond coronary angiography? Results from the "Evaluation of the clinical Profile, Investigations and Cardiac Imaging of the Patients with MINOCA (EPIC-MINOCA Study)". Egypt Heart J 2024; 76:96. [PMID: 39098941 PMCID: PMC11298506 DOI: 10.1186/s43044-024-00530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/29/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Evaluation of the patients with MINOCA and identifying the underlying aetiology remains challenging. However, investigation in most patients remains limited to coronary angiography (CAG). The study aimed to assess the clinical profile, investigations and cardiac imaging of the patients with MINOCA and its outcomes. RESULTS Out of 55 patients with MINOCA, CAG was normal in 16 (29.1%), while 39 (69.9%) had nonobstructive coronary artery disease. Of 55 patients, 34 had limited workup (Group 1) and only 21 had advanced workup (Group 2). In comparison to Group 1, Group 2 had a significantly higher association with the identification of possible underlying aetiology (16 vs. 4, p < 0.001) and a change in the management (10 vs. 3, p = 0.002). CONCLUSION Diagnostic workup in patients with MINOCA was limited to CAG in 61.8% of patients in this study. However, patients with advanced workup had a significantly higher association with the change in the treatment and identifying possible underlying aetiology in such patients.
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Affiliation(s)
| | | | - Shishir Soni
- Super-Specialty Hospital (SSH), NSCB Medical College, Jabalpur, MP, India.
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Yildiz M, Ashokprabhu N, Shewale A, Pico M, Henry TD, Quesada O. Myocardial infarction with non-obstructive coronary arteries (MINOCA). Front Cardiovasc Med 2022; 9:1032436. [PMID: 36457805 PMCID: PMC9705379 DOI: 10.3389/fcvm.2022.1032436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is evident in up to 15% of all acute myocardial infarctions (AMI) and disproportionally affects females. Despite younger age, female predominance, and fewer cardiovascular risk factors, MINOCA patients have a worse prognosis than patients without cardiovascular disease and a similar prognosis compared to patients with MI and obstructive coronary artery disease (CAD). MINOCA is a syndrome with a broad differential diagnosis that includes both ischemic [coronary artery plaque disruption, coronary vasospasm, coronary microvascular dysfunction, spontaneous coronary artery dissection (SCAD), and coronary embolism/thrombosis] and non-ischemic mechanisms (Takotsubo cardiomyopathy, myocarditis, and non-ischemic cardiomyopathy)-the latter called MINOCA mimickers. Therefore, a standardized approach that includes multimodality imaging, such as coronary intravascular imaging, cardiac magnetic resonance, and in selected cases, coronary reactivity testing, including provocation testing for coronary vasospasm, is necessary to determine underlying etiology and direct treatment. Herein, we review the prevalence, characteristics, prognosis, diagnosis, and treatment of MINOCA -a syndrome often overlooked.
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Affiliation(s)
- Mehmet Yildiz
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Namrita Ashokprabhu
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Aarushi Shewale
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Madison Pico
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Timothy D. Henry
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
| | - Odayme Quesada
- The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital, Cincinnati, OH, United States
- Women’s Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, OH, United States
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Stepien K, Nowak K, Kachnic N, Horosin G, Walczak P, Karcinska A, Schwarz T, Wojtas M, Zalewska M, Pastuszak M, Wegrzyn B, Nessler J, Zalewski J. Statin Use in Cancer Patients with Acute Myocardial Infarction and Its Impact on Long-Term Mortality. Pharmaceuticals (Basel) 2022; 15:ph15080919. [PMID: 35893743 PMCID: PMC9330549 DOI: 10.3390/ph15080919] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Statin use and its impact on long-term clinical outcomes in active cancer patients following acute myocardial infarction (MI) remains insufficiently elucidated. Of the 1011 consecutive acute MI patients treated invasively between 2012 and 2017, cancer was identified in 134 (13.3%) subjects. All patients were observed within a median follow-up of 69.2 (37.8−79.9) months. On discharge, statins were prescribed less frequently in MI patients with cancer as compared to the non-cancer MI population (79.9% vs. 91.4%, p < 0.001). The most common statin in both groups was atorvastatin. The long-term mortality was higher in MI patients not treated vs. those treated with statins, both in non-cancer (29.5%/year vs. 6.7%/year, p < 0.001) and cancer groups (53.9%/year vs. 24.9%/year, p < 0.05), respectively. Patient’s age (hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.03−1.05, p < 0.001, per year), an active cancer (HR 2.42, 95% CI 1.89−3.11, p < 0.001), hemoglobin level (HR 1.14, 95% CI 1.09−1.20, p < 0.001, per 1 g/dL decrease), and no statin on discharge (HR 2.13, 95% CI 1.61−2.78, p < 0.001) independently increased long-term mortality. In MI patients, simultaneous diagnosis of an active cancer was associated with less frequently prescribed statins on discharge. Irrespective of cancer diagnosis, no statin use was found as an independent predictor of increased long-term mortality.
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Affiliation(s)
- Konrad Stepien
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
- “Club 30”, Polish Cardiac Society, 00-193 Warsaw, Poland
- Correspondence: ; Tel.: +48-12-6142218
| | - Karol Nowak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
| | - Natalia Kachnic
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Grzegorz Horosin
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Piotr Walczak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Aleksandra Karcinska
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Tomasz Schwarz
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
- Department of Genetics, Animal Breeding and Ethology, University of Agriculture in Krakow, 31-059 Krakow, Poland
| | | | - Magdalena Zalewska
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland;
| | | | - Bogdan Wegrzyn
- Department of Social Work, University of Applied Sciences in Tarnow, 33-100 Tarnow, Poland;
| | - Jadwiga Nessler
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
| | - Jarosław Zalewski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, 31-202 Krakow, Poland; (K.N.); (N.K.); (G.H.); (P.W.); (A.K.); (J.N.); (J.Z.)
- Cardiocare, 31-159 Krakow, Poland; (T.S.); (M.W.)
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