Abstract
With the emerging interest in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA), there is a need to define an even broader group of patients with the syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA). There are limited data on the clinical characteristics and prognoses of such patients who present with symptoms of acute coronary syndrome (ACS) and undergo urgent coronary angiography that reveals no significant lesions. The aim of this observational study was to compare patients with ACS INOCA and those with ACS with obstructive coronary artery disease (OCAD) both within unadjusted cohorts and with propensity score matched controls. This observational study was based on the data from the Polish National Registry of Invasive Cardiology Procedures. Of 9744 patients included, 7624 had OCAD and 2120 had ACS INOCA. In unadjusted cohorts, the overall survival and incidence of major adverse cardiovascular events (MACE: death, cardiac arrest, myocardial infarction, stroke, and heart failure hospitalization) until 36 months were higher in patients with ACS OCAD. Following propensity matching, higher win ratios of death (p = 0.02), additional revascularizations by percutaneous coronary intervention or coronary artery bypass graft surgery (p<0.001), and cardiac hospitalization (p<0.001) were observed in these patients. In contrast, the win ratios of myocardial infarction (p = 0.74), heart failure hospitalization (p = 0.86), and MACE (p = 0.07) were not significantly different between the groups. The prognosis of patients with ACS INOCA was more favorable than that of patients with ACS OCAD; however, the differences diminished after adjustments for the initial clinical profiles. An ACS incident should not be judged as trivial even when cardiac markers remain stable and no significant lesions are found on angiography.
Highlights
More than 10% of patients who present with symptoms suggestive of acute myocardial infarction have no significant atherosclerotic plaques on coronary angiography
The prognosis of patients with acute coronary syndrome (ACS) ischemia with non-obstructive coronary arteries (INOCA) was more favorable than that of patients with ACS obstructive coronary artery disease (OCAD); the differences diminished after adjustments for the initial clinical
The diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) is established immediately in a patient who presents with features consistent with acute myocardial infarction, non-obstructive coronary arteries on angiography and no clinically specific cause for the acute presentation [2]
Summary
More than 10% of patients who present with symptoms suggestive of acute myocardial infarction have no significant atherosclerotic plaques on coronary angiography This clinical condition has been termed myocardial infarction with non-obstructive coronary arteries (MINOCA) [1]. The diagnosis of MINOCA is established immediately in a patient who presents with features consistent with acute myocardial infarction, non-obstructive coronary arteries on angiography and no clinically specific cause for the acute presentation [2]. Another group of patients present with symptoms suggestive of acute coronary ischemia and undergo urgent coronary angiography despite negative cardiac biomarkers. A new concept has been proposed to define an even broader group of patients with syndrome of myocardial ischemia with non-obstructive coronary arteries (INOCA) [3]
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