Abstract
Background and Objectives: A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). Thus, the aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis. Materials and Methods: We selected 337 consecutive patients admitted to hospital with a working diagnosis of MINOCA. The patients were divided in three groups according to the extent of hs-TnI increase during hospitalization (increase ≤5-times above the limit of the upper norm, >5 and ≤20-times, and >20-times). The study endpoints included all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE; cerebral stroke and transient ischemic attacks, MI, coronary artery revascularization, either percutaneous coronary intervention or coronary artery bypass grafting and all-cause mortality). Results: During the mean follow-up period of 516.1 ± 239.8 days, using Kaplan–Meier survival curve analysis, significantly higher mortality rates were demonstrated among patients from the group with the greatest hs-TnI increase compared to the remaining groups (p = 0.01) and borderline values for MACCE (p = 0.053). Multivariable cox regression analysis did not confirm hs-TnI among factors related to increased MACCE or all-cause mortality rates. Conclusion: While a relationship between clinical outcomes and the extent of the hs-TnI increase among patients with a MINOCA working diagnosis remains, it does not seem to be not as strong as it is in patients with obstructive coronary atherosclerosis.
Highlights
Acute myocardial infarction (AMI) with non-obstructive coronary arteries defined as lack of relevant stenosis in coronary angiography has currently become an interesting topic [1].The prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) among patients admitted to hospital with acute coronary syndrome (ACS) is estimated to be at 6% [2,3].Diagnosis of MI and non-obstructive coronary atherosclerosis (MINOCA) is considered working, due to its various etiologies often requiring prolonged diagnostics and specific treatment [4]
While the relationship between clinical outcomes and the extent of high sensitive troponin I (hs-TnI) increase during hospitalization in patients with a working diagnosis of MINOCA remains visible, it is not as strong as it is in patients with obstructive coronary atherosclerosis
The use of the working MINOCA diagnosis to calculate all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE) predictors may introduce some distortions or inaccuracies, because one of these patients will eventually be removed from the MINOCA group to other groups, e.g., myocarditis or takotsubo cardiomyopathy
Summary
Acute myocardial infarction (AMI) with non-obstructive coronary arteries defined as lack of relevant (over 50%) stenosis in coronary angiography has currently become an interesting topic [1].The prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) among patients admitted to hospital with acute coronary syndrome (ACS) is estimated to be at 6% [2,3].Diagnosis of MINOCA is considered working, due to its various etiologies often requiring prolonged diagnostics and specific treatment [4]. The prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) among patients admitted to hospital with acute coronary syndrome (ACS) is estimated to be at 6% [2,3]. In the ACUITY (“Acute Catheterization and Urgent Intervention Triage Strategy”) trial patients with MINOCA, the 1-year death rate was higher than in the case of non-ST-segment elevation myocardial infarction (NSTEMI) patients with myocardial infarction and obstructive coronary artery disease (MI-CAD), mostly caused by non-cardiac mortality [6]. A topic already widely investigated is the negative prognostic value regarding the extent of high sensitive troponin I (hs-TnI) increases among patients with myocardial infarction (MI) and obstructive coronary atherosclerosis compared to a group of patients with MI and non-obstructive coronary atherosclerosis (MINOCA). The aim of this study was to evaluate the prognostic value concerning the extent of hs-TnI increase on clinical outcomes among patients with a MINOCA working diagnosis.
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