Clinical Features and Long-Term Outcomes in Very Young Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

Sex differences in delay times in ST-segment elevation myocardial infarction: A cohort study

BACKGROUND

The present study analyzes a cohort of consecutive patients with ST-segment elevation acute myocardial infarction (STEMI), evaluating the ischemia-reperfusion times from the perspective of gender differences (females versus males), with a long-term follow-up.

METHODS

Single-center analytical cohort study of patients with STEMI in a tertiary hospital, between January 2015 and December 2020.

RESULTS

A total of 2668 patients were included, 2002 (75%) men and 666 (25%) women. The time elapsed from the onset of symptoms to the opening of the artery was 197min (IQR 140-300) vs 220min (IQR 152-340), p=0.004 in men and women respectively. A delay in health care significantly impacts the occurrence of cardiovascular adverse events at follow-up, HR 1.34 [95%CI 1.06-1.70]; p=0.015.

CONCLUSIONS

Women took longer to go to health care services and had a longer delay both in the diagnosis of STEMI and in coronary reperfusion. It is imperative to emphasize the necessity of educating women about the recognition of ischemic heart disease symptoms, empowering them to raise early alarms and seek timely medical attention.

Long-term outcomes in very young patients with myocardial infarction with non-obstructive coronary arteries

Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) covers an expanding group of patients over recent years. Previous studies showed considerable risks of outcomes in this group. However, there is a lack of evidence in young patients with MINOCA. In this study, we aimed to investigate the long-term outcomes in very young patients with MINOCA. We retrospectively compared the features and predictors of 183 very young (≤40-year-old) patients to >40-year-old patients with MINOCA. We compared the baseline characteristics and major adverse cardiac events (total MI, revascularization and mortality) rates between the groups during a median follow-up of 7.3 years. We performed the Cox regression analysis to investigate the risk factors for mortality. We found that the ≤40-year-old group with MINOCA had 12% mortality rates during the follow-up. They had significantly lower rates of diabetes and hypertension and higher rates of male gender and smoking compared to the older group. The very young group also had lower rates of CRF, previous MI and atrial fibrillation. The ≤40-year-old groups received significantly lower rates of medications. Ejection fraction (EF) <30% was independently associated with 6-fold increases in total mortality [hazard ratio (HR) = 6.23, 95% confidence interval (CI) 1.42-27.2, P = 0.02] in the ≤40-year-old group. In conclusion, the ≤40-year-old patients with MINOCA have substantial long-term mortality rates. EF <30% was independently associated with total mortality in this group. Moreover, the ≤40-year-old group also received less intense medical therapy compared to their older counterparts.

Prognostic Role of Early Cardiac Magnetic Resonance in Myocardial Infarction With Nonobstructive Coronary Arteries

BACKGROUND

Cardiac magnetic resonance (CMR) plays a pivotal diagnostic role in myocardial infarction with nonobstructive coronary arteries (MINOCA). To date, a prognostic stratification of these patients is still lacking.

OBJECTIVES

This study aims to assess the prognostic role of CMR in MINOCA.

METHODS

The authors assessed 437 MINOCA from January 2017 to October 2021. They excluded acute myocarditis, takotsubo syndromes, cardiomyopathies, and other nonischemic etiologies. Patients were classified into 3 subgroups according to the CMR phenotype: 1) presence of late gadolinium enhancement (LGE) and abnormal mapping (M) values (LGE+/M+); 2) regional ischemic injury with abnormal mapping and no LGE (LGE-/M+); and 3) nonpathological CMRs (LGE-/M-). The primary outcome was the presence of major adverse cardiovascular events (MACE). The mean follow-up was 33.7 ± 12.0 months and CMR was performed on average at 4.8 ± 1.5 days from the acute presentation.

RESULTS

The final cohort included 198 MINOCA; 116 (58.6%) comprised the LGE+/M+ group. During follow-up, MACE occurred significantly more frequently in MINOCA LGE+/M+ than in the LGE+/M- and normal-CMR (LGE-/M-) subgroups (20.7% vs 6.7% and 2.7%; P = 0.006). The extension of myocardial damage at CMR was significantly greater in patients who developed MACE. In multivariable Cox regression, %LGE was an independent predictor of MACE (HR: 1.123 [95% CI: 1.064-1.185]; P < 0.001) together with T2 mapping values (HR: 1.190 [95% CI: 1.145-1.237]; P = 0.001).

CONCLUSIONS

In MINOCA with early CMR execution, the %LGE and abnormal T2 mapping values were identified as independent predictors of adverse cardiac events at ∼3.0 years of follow-up. These parameters can be considered as high-risk markers in MINOCA.

Comparison of Long-Term Outcomes of Patients With Myocardia Infarction (MI) With Non-obstructive Coronary Arteries and MI With Obstructive Coronary Arteries: A Systematic Review and Meta-Analysis

The aim of this study was to compare long-term outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and patients with myocardial infarction with obstructive coronary arteries (MIOCA). This meta-analysis was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature search was conducted in online databases including PubMed and Web of Science from 2010 onwards. Primary outcomes assessed in this meta-analysis included major adverse cardiovascular events (MACE) and all-cause mortality. Secondary outcomes included cardiovascular mortality and myocardial infarction. A total of 16 studies were included in the meta-analysis. Pooled analysis showed that the risk of MACE was higher in MIOCA patients (risk ratio (RR): 1.47, 95%CI: 1.43-1.52, p-value: 0.001) compared to MINOCA patients. Additionally, the risk of all-cause mortality was also significantly higher in MIOCA patients compared to MINOCA (RR: 1.33, 95%CI: 1.14-1.56, p-value: 0.001). Our findings also indicate that patients with MIOCA are at a significantly higher risk of recurrent myocardial infarction and cardiovascular-related mortality compared to patients with MINOCA. Overall, the insights gained from this meta-analysis have significant clinical implications, guiding decision-making in the management of patients with MINOCA.