Application of the VIRGO taxonomy to differentiate acute myocardial infarction in young women

Abstract

BackgroundA sex-specific taxonomy was developed from the Variation in Recovery: Role of Gender Outcomes of Young AMI patients (VIRGO) study to better classify young women with AMI who received cardiac catheterization. We aim to determine whether this taxonomy is advantageous to the Universal Definition. MethodsWe conducted a single-center retrospective chart review of consecutive women aged ≤55 years presenting with AMI between 1/1/2013 to 9/1/2016 who underwent cardiac catheterization during the index admission. The proportion of women classified using the Universal Definition of MI and VIRGO classification systems were compared. ResultsAmong women with AMI who underwent cardiac catheterization (n = 177), using the Universal Definition of MI, 68.4% were classified as Type 1, 11.9% as Type 2, and 2.3% as Type 4b; 17.5% were unclassified. Using the VIRGO taxonomy, most (68.4%) were classified as Class I (thrombosis/critical stenosis). The remaining patients were stratified by the presence of obstructive coronary artery disease (CAD) with demand (Class IIa: 4.0%) and without demand (Class IIb: 2.3%) versus non-obstructive CAD with demand (Class IIIa: 6.8%) and without demand (Class IIIb: 10.2%). Alternative discreet mechanisms (Class IV) were seen in 7.3%. Only 1.1% was unclassified. ConclusionsIn a cohort of young women with AMI, 1 in 3 patients who underwent cardiac catheterization did not exhibit the classic mechanism of plaque disruption/thrombosis. By comparison, the VIRGO taxonomy classified more young women and further distinguished presentations within categories of the Universal Definition of MI. Application of this nuanced taxonomy may support the development of individualized diagnostic and treatment strategies in young women with AMI.