Myocardial Infarction With Non-obstructive Coronary Arteries Patients Research Articles

Leukocyte telomere length and lipid parameters in patients with myocardial infarction with non-obstructive coronary arteries.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined as stenosis of less than 50% or no stenosis on coronary angiography in a patient diagnosed with myocardial infarction. Telomere length is expressed by studies that it acts as a biomarker, especially for biological aging and cardiovascular diseases. In this study, we aimed to investigate whether there is a relationship between circulating leukocyte telomere length (LTL) and serum lipid values in MINOCA patients. Forty-five newly diagnosed patients with MINOCA were included in the study, along with 45 healthy controls who matched the patients in terms of age and gender. We determined the LTL value using the RT-PCR method. As a result of the study, we found LTL (p< 0.001) and serum lipid values (HDL-cholesterol (p< 0.001), LDL-cholesterol (p< 0.001), triglycerides (p< 0.05), and total cholesterol (p< 0.05)) to be significantly higher in the MINOCA group than in the control group. When the correlation relationship between LTL and lipid values in the MINOCA group was evaluated, a negative correlation was determined only between LTL and HDL (p=0.014, r=-0.362). This is the first study to evaluate telomere length in MINOCA patients in Turkey. Our results support the existence of short telomere length in MINOCA patients.

The Role of Antiplatelet Therapy in Patients With MINOCA.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities characterized by the common clinical evidence of myocardial infarction (MI) with non-obstructive coronary arteries on coronary angiography and without an overt cause for the MI. Platelets play a cornerstone role in the pathophysiology of MI with obstructive coronary arteries. Accordingly, antiplatelet therapy is recommended for treating patients with MI and obstructive coronary disease. However, the role of platelets in the pathophysiology of MINOCA patients is not fully defined, questioning the role of antiplatelet therapy in this setting. In this review, we will assess the role of antiplatelet therapy in MINOCA with a focus on the pathophysiology, therapeutic targets, current evidence, and future directions according to its different etiologies.

Metabolic syndrome and the risk of adverse cardiovascular events in patients with myocardial infarction with non-obstructive coronary arteries

Background and aimsMetabolic syndrome (MeS) is recognized as a significant predictor of poor outcomes in coronary artery disease. However, its prognostic implications in myocardial infarction with non-obstructive coronary arteries (MINOCA) have not been examined. We aimed at investigating the role of MeS on the clinical outcomes in MINOCA patients. Methods and resultsPatients diagnosed with MINOCA between 2015 and 2019 were included. MeS was defined according to modified NCEP-ATPIII criteria. The primary endpoint was major adverse cardiovascular events (MACE). Cox regression analysis was used to evaluate the correlation between MeS and the hazard of MACE. The integrated discrimination improvement (IDI) and net reclassification index (NRI) were performed to assess MeS incremental predictive value. Of 281 MINOCA patients, 83 (29.5%) patients satisfied the MeS criteria. During a median follow-up duration of 28 months, MINOCA patients with MeS had a notably higher rate of MACE than those without MeS (30.1% vs. 17.6%, respectively P = 0.020). Cox regression analysis revealed that MeS was associated with an increased hazard of MACE (adjusted HR 2.126; 95% CI: 1.193–3.787, P = 0.010). When each component of MeS was analyzed as a categorized variable separately, only high fasting blood glucose and BMI ≥25 kg/m2 were associated with an increased hazard of MACE. Moreover, MeS had an incremental predictive ability for MACE when added to a model with clinical risk factors. ConclusionMeS is relatively common in patients with MINOCA. The presence of MeS significantly increased the hazard of MACE among the MINOCA population.

Myocardial infarction with non obstructive coronary arteries (Minoca): Specificities and short-term outcomes in a Sub-Saharan African setting

To describe the characteristics and management of myocardial infarction with non obstructive coronary arteries (MINOCA) at the Abidjan Heart Institute. Observational cross-sectional survey from January 1, 2010 to June 30, 2020 including patients aged > 18 y.o. who underwent coronary angiography for myocardial infarction (MI). Baseline and angiographic data, and short-term outcomes were analyzed and compared between patients with angiographic obstructive coronary artery disease (CAD) and MINOCA. Seven hundred and eighteen patients hospitalized for an acute MI were included over the study period, and 65 (9%) met the definition of MINOCA. Patients with MINOCA were younger with a mean age of 43.2 ± 10 y versus 56.2 ± 10 y. MINOCA patients were more frequently free of classical risk factors ( P = 0.03). MI without ST-segment elevation was more common in MINOCA patients (55.4%; P < 0.0001). Main etiologies in MINOCA were coagulation disorders (6.1%), coronary spasm (6.1%), type I MI with no angiographic obstructive CAD (4.6%), coronary dissection (4.6%) and coronary embolism (3.1%). In 72% of cases, the etiology could not be specified. Complications were observed in 12% of cases and no patient with MINOCA died. MINOCA is a common clinical entity with good outcomes in young patients presenting for an acute MI. Aetiological screening is often challenging in our practice.

Myocardial Bridging is Significantly Related to Myocardial Infarction with Non-Obstructive Coronary Artery Disease

Myocardial infarction with non obstructive coronary arteries (MINOCA) is a complex working diagnosis including coronary and non-coronary causes, like spontaneous coronary dissection, coronary thrombosis or embolism, myocarditis and cardiomyopathy. The prevalence of MINOCA is increasing, but the underlying etiology remains undetermined in more than 10% of cases. Hypotheses on the potential contributing role of myocardial bridge (MB) in takotsubo cardiomyopathy and coronary artery spasm (CAS) have been raised. We aim to investigate the relationship between MB and MINOCA. An observational retrospective study was conducted on 15,036 patients who had been referred for coronary angiography and who fulfilled the Definition of Myocardial Infarction. The study population was divided into STEMI and Non-STEMI patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. The prevalence of MB was calculated in each group ( Fig. 1 ). The distribution of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%, P < 0.001). MINOCA accounted for 14.5% of spontaneous myocardial infarctions, and the clinical presentation was frequently NSTEMI rather than STEMI (84.3% vs. 15.7%, P < 0.001). Adjusted multivariate analyses showed a positive association between MB and MINOCA [OR = 3.28, 95% CI (2.34; 4.61) P < 0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female. The main finding of the present study was that MB is an independent predictor for MINOCA, increasing the corresponding risk by threefold. Because MB prevalence differed significantly between the controls (CAD group) and in the MINOCA group, which was positively correlated to MB, it seems likely that MB would be a potential cause of MINOCA. Future prospective studies are necessary to highlight the physiologic significance of MB in some MINOCA patients.

Real-World Use of Clopidogrel and Ticagrelor in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: Patient Characteristics and Long-Term Outcomes

Background: Current guidelines recommend ticagrelor as the preferred P2Y12 inhibitor on top of aspirin in patients after an acute coronary syndrome. Yet, the efficacy and safety of ticagrelor vs. clopidogrel in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) remain uncertain.Methods: A total of 1,091 patients with MINOCA who received dual antiplatelet therapy were enrolled and divided into the clopidogrel (n = 878) and ticagrelor (n = 213) groups. The primary efficacy endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure. The safety endpoint referred to bleeding events. The Kaplan-Meier, propensity score matching (PSM), and Cox regression analyses were performed.Results: The incidence of MACE was similar for clopidogrel- and ticagrelor-treated patients over the median follow-up of 41.7 months (14.3 vs. 15.0%; p = 0.802). The use of ticagrelor was not associated with a reduced risk of MACE compared with clopidogrel after multivariable adjustment in overall (HR = 1.25, 95% CI: 0.84–1.86, p = 0.262) and in subgroups of MINOCA patients. Further, there was no significant difference in the risk of bleeding between two groups (HR = 1.67, 95% CI: 0.83–3.36, p = 0.149). After PSM, 206 matched pairs were identified, and the differences between clopidogrel and ticagrelor for ischemic endpoints and bleeding events remained nonsignificant (all p > 0.05).Conclusions: In this observational analysis of MINOCA patients, ticagrelor was not superior to clopidogrel in reducing ischemic events and did not cause a significant increase in bleeding, indicating a similar efficacy and safety between clopidogrel and ticagrelor. A randomized study of ticagrelor vs. clopidogrel in this specific population is needed.

623 Coronary ectasia in different clinical subsets: stable and acute coronary syndromes

Abstract Aims Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis. Methods and results A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients. Conclusions CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.

Hyperuricemia as a prognostic marker for long-term outcomes in patients with myocardial infarction with nonobstructive coronary arteries

BackgroundHyperuricemia (HUA) has been proved as a predictor of worse outcomes in patients with coronary artery disease. Here, we investigated the prognostic value of HUA in a distinct population with myocardial infarction with nonobstructive coronary arteries (MINOCA).MethodsA total of 1179 MINOCA patients were enrolled and divided into HUA and non-HUA groups. HUA was defined as a serum uric acid level ≥ 420 μmol/L in men or ≥ 357 μmol/L in women. The primary study endpoint was a composite of major adverse cardiovascular events (MACE), including all-cause death, nonfatal MI, nonfatal stroke, revascularization, and hospitalization for unstable angina or heart failure. Kaplan–Meier, Cox regression, and receiver-operating characteristic analyses were performed.ResultsPatients with HUA (prevalence of 23.5%) had a significantly higher incidence of MACE (18.7% vs. 12.8%; p = 0.015) than patients without during the median follow-up of 41.7 months. HUA was closely associated with an increased risk of MACE even after multivariable adjustment (hazard ratio 1.498, 95% confidence interval: 1.080 to 2.077; p = 0.016). HUA remained a robust risk factor of MACE after propensity score matching analysis. Moreover, HUA showed an area under the curve (AUC) of 0.59 for predicting MACE. Incorporation of HUA to the thrombolysis in myocardial infarction (TIMI) score yielded a significant improvement in discrimination for MACE.ConclusionsHUA was independently associated with poor prognosis after MINOCA. Routine assessment of HUA may facilitate risk stratification in this specific population.

Clinical presentation, treatment and 2-year prognosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): A single centre study in Malaysia

Recent studies showed MINOCA patients have comparable clinical outcomes to myocardial infarction with obstructive coronary artery disease (MI-CAD) patients. Data from the Malaysian population is however still lacking.

Antiphospholipid antibodies in patients with myocardial infarction with and without obstructive coronary arteries.

Recent studies demonstrate that prothrombotic antiphospholipid antibodies (aPL) are overrepresented in patients with myocardial infarction (MI) due to coronary artery disease (MICAD). However, it is not known whether aPL differ between the two subsets of MI: MICAD and MI with nonobstructive coronary arteries (MINOCA). To determine whether aPL are associated with MINOCA or MICAD, or with hypercoagulability as assessed by activated protein C-protein C inhibitor (APC-PCI) complex. Well-characterized patients with MINOCA (n = 98), age- and gender-matched patients with MICAD (n = 99), and healthy controls (n = 100) were included in a cross-sectional case-control study. Autoantibodies (IgA/G/M) targeting cardiolipin and β2 glycoprotein-I and specific nuclear antigens were analyzed by multiplexed bead technology. The concentration of APC-PCI was determined as a measure of hypercoagulability by an immunofluorometric sandwich assay. Both prevalence and titers of aPL of the IgG isotype (anti-cardiolipin and/or anti-β2 glycoprotein-I) were higher in patients with MINOCA and MICAD than in controls. aPL IgG positivity was twice as frequent among patients with MICAD than MINOCA (11% vs. 6%, nonsignificant). We observed no group differences regarding aPL IgA/M or antibodies targeting specific nuclear antigens. Levels of APC-PCI were elevated in aPL IgG-positive compared to aPL IgG-negative MICAD patients. aPL IgG, but not IgA/M, are enriched particularly in patients with MICAD but also in patients with MINOCA, as compared to controls. Interestingly, signs of hypercoagulability-measured by increased levels of the APC-PCI complex-were present in aPL IgG-positive MICAD patients, indicating an association with functional disturbances of the coagulation system.

The Pivotal Role of Invasive Functional Assessment in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA).

Myocardial infarction with non-obstructive coronary arteries (MINOCA) encompasses several pathophysiological mechanisms not yet fully understood. Among the latter, vasomotion abnormalities and coronary microvascular dysfunction (CMD) play a major role for both epidemiological and prognostic reasons. Despite current guidelines do not recommend routine physiological assessment of both epicardial and microvascular coronary compartments within the context of an acute myocardial infarction, several recent evidence support the critical role of a comprehensive invasive functional assessment in order to identify the underlying pathophysiological mechanism and consequently to select an appropriate therapeutic strategy. Unfortunately, optimal medical therapy for these patients is not currently established due to the lack of dedicated trials evaluating clinical outcomes of commonly used medications for secondary prevention in MINOCA patients. For this reason, additional research is warranted to provide personalized treatments for patients affected by this puzzling clinical entity.

Abstract 13449: Myocardial Infarction With Non-Obstructive vs Obstructive Coronary Arteries Among Patients With Acute Coronary Syndrome at a Large Safety-Net Hospital

Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) has been increasingly recognized. The differences between MINOCA and obstructive coronary artery disease (OCAD) patients have not been studied in lower socioeconomic status populations. Methods: The records of all patients undergoing angiography for ACS at a large Dallas County safety-net hospital from January 2018 to January 2020 were reviewed and categorized as MINOCA or OCAD. Results: During the study period, 592 cases of acute coronary syndrome (ACS) were identified; 10.8% (n=64) were MINOCA. OCAD patients had higher peak pre-angiography troponin compared with MINOCA patients (2498 vs 335 ng/L, p&lt;0.001). MINOCA patients were younger compared with OCAD patients (56 vs 60 y, p=0.01), while MINOCA men were younger than MINOCA women (53 vs 61 y, p=0.009). A higher proportion of MINOCA patients were Black, compared with OCAD (Figure 1). MINOCA patients had a lower prevalence of dyslipidemia and diabetes mellitus but there were no differences in the prevalence of smoking, hypertension, family history of premature CAD, current dialysis or heart failure between the groups. There were no differences in statin, aspirin, beta blocker or calcium channel blocker prescription at presentation between MINOCA and OCAD patients, regardless of sex. The majority of MINOCA patients (75%) did not have a definitive etiology of their ACS event by discharge. Conclusions: In this analysis of ACS patients presenting to a large safety-net hospital, MINOCA was common and MINOCA patients had many traditional risk factors. Men presented with MINOCA more commonly than has been seen in other studies. More Black patients presenting with ACS had MINOCA vs OCAD, likely reflecting the higher rates of left ventricular hypertrophy and diabetes in these patients. Lack of a definitive diagnosis for most MINOCA patients may reflect unfamiliarity with the diagnostic workup of MINOCA patients.

Abstract 11260: Psychosocial Factors Amongst Women with MINOCA

Introduction: Women are particularly vulnerable to high stress and depression after myocardial infarction (MI), and both are associated with increased post-MI mortality. MI with non-obstructive coronary arteries (MINOCA) disproportionately affects women. Little is known about the degree to which stress and depression levels around the time of MI relate to the type of MI in women. We aimed to determine whether psychosocial factors differ between women with MINOCA and those with MI and obstructive CAD (MI-CAD). Methods: Women with MI enrolled in a multicenter study completed baseline measures of perceived stress (Perceived Stress Scale [PSS-4]), depressive symptoms (Patient Health Questionnaire [PHQ-2]), major life stressors (life events checklist [LEC]) and psychological resilience (Brief Resilience Scale [BRS]) at the time of hospitalization for acute MI. PSS-4 and PHQ-2 were repeated at 2-months post-MI. Psychosocial measures were compared between patients with MINOCA and those with MI-CAD at baseline and 2-month follow-up using t-test and chi-square. Results: This study compared 172 MINOCA patients and 314 MI-CAD patients. Women with MINOCA were younger (59.4±12.5 vs 64.2±12.9 years, p&lt;0.001) and less likely to be non-Hispanic white (52.3% vs 64.3%, p=0.004). Women with MINOCA were less likely to have high stress (PSS-4 ≥6) at the time of MI (51.0% vs 63.0% vs, p=0.021) and at 2-months post-MI (32.5% vs 46.3%, p=0.019) compared to women with MI-CAD. There was no difference in the proportion with depressive symptoms (PHQ-2 ≥2) at the time of MI (36.2% MINOCA vs 42.7% MI-CAD, p=0.23) or at 2-months post-MI (39.0% vs 39.5%, P&gt;0.99). MINOCA patients reported fewer major life stressors than MI-CAD patients (LEC 2.67±1.93 vs 3.13±1.80, p=0.015). The frequency of low psychological resilience (BRS&lt;18) (24.3% vs 21.6%, p=0.60) did not differ between MINOCA and MI-CAD patients. Conclusions: Stress and depression are common among women at the time of, and 2-months post-MI. MINOCA patients reported lower stress levels at the time of and following MI compared to MI-CAD patients and fewer traumatic life events, but depressive symptoms and resilience did not differ by MI type.

Abstract 10785: Cardiac Magnetic Resonance Imaging and Optical Coherence Tomography in Patients with a Clinical Diagnosis of Myocardial Infarction with Non-Obstructive Coronary Arteries - A Systematic Review and Meta-Analysis

Background: Myocardial Infarction with Non-Obstructive Coronary arteries (MINOCA) is defined as acute Myocardial Infarction (MI) despite the absence of severe coronary artery stenosis on angiography (i.e., stenosis severity &lt;50%) and no specific alternative diagnosis (e.g., sepsis, pulmonary embolism). MINOCA remains a serious diagnostic and therapeutic challenge given the various possible underlying etiologies. Cardiac Magnetic Resonance Imaging (CMR) can distinguish between acute myocarditis (AM), MI, and Takotsubo cardiomyopathy (TCM) which are some of the commonest causes of MINOCA. Hence, The European Society of Cardiology (ESC) recommend CMR in all MINOCA patients with an unclear etiology. Intracoronary Optical coherence tomography (OCT) is a high-resolution imaging modality that allows for assessment of the integrity of the atheroma. We aimed to study the efficacy of CMR and OCT in detecting the etiology in MINOCA patients, which has the potential to guide medical therapy. Methods: A systematic search was made in PubMed, Medline and Cochrane database. Search terms used: Myocardial infarction, Coronary angiography, Normal coronary arteries, CMR, and OCT. Inclusion criteria was fulfilled by 18 studies. Meta-analysis and meta-regression was performed with 14 studies due to increased heterogeneity. Results: A total of 2474 patients were included in the meta-analysis. The mean age of all the patients was 51.5 and 56.4% were men. CMR was able to establish diagnosis in 74% of the patients; 30.4% had AM, 21.3% had true MI and 12% had TCM. Upon meta-regression the demographic variables, cardiovascular risk factors, troponin levels and C-reactive protein levels did not have any association with AM or MI. Incorporation of OCT with CMR was better at finding the etiology than either modalities individually. Conclusion: CMR is integral in finding the cause of MINOCA. Coupling coronary OCT and CMR is better than either techniques alone at identifying the etiology.

Abstract 12075: Utility of Cardiac MRI for Assessment of Patients with Myocardial Infarction and Non-Obstructive Coronary Arteries: 5-Year Experience in a Tertiary Care Center in Latin-America

Introduction: Acute myocardial infarction with non-obstructive coronary arteries (MINOCA) is a frequent condition caused by a wide array of diseases. Absence of a definitive diagnosis can difficult proper treatment and may worsen prognosis. Given its unique ability to achieve tissue characterization, cardiac magnetic resonance (CMR) can be extremely useful in these patients. We sought to describe the use of CMR in a tertiary care center in Latin-America for the evaluation of MINOCA and its impact in patient management. Methods: Cross-sectional study of all hospitalized patients with MINOCA undergoing CMR and impact in medical management at discharge based on its result. Results: A total of 3283 patients underwent CMR between 2016 and 2020 in our institution. Of these, 144 had MINOCA (without IVUS/OCT imaging) as the main indication for the study. Mean age was 50.7 ± 14.8 years and 56.9% were females. The most frequent diagnosis after CMR was myocarditis in 50% of cases (n=71) followed by AMI in 22% (n=31) and Tako-Tsubo Syndrome in 12% (n=17). Only 11% (n=15) of CMR were normal (Fig 1). There were significant changes in prescription before and after CMR of ASA, dual-antiplatelet therapy (DAPT), anticoagulants (AC), betablockers (BB), statins, colchicine and NSAIDs (Fig 2). Conclusions: CMR is critical for making a definitive diagnosis in a substantial proportion of MINOCA patients and its use has a significant impact in medical regimen optimization at discharge. Figure 1. Definite diagnosis achieved after CMR. AMI: Acute Myocardial Infarction. CMP: Cardiomyopathies. HCM: Hypertrophic Cardiomyopathy. TS: Takotsubo Syndrome.Figure 2. Changes in prescription before and after CMR.

Myocardial infarction with non obstructive coronary arteries (MINOCA) according to definitions of 2020 ESC Guidelines: clinical profile and prognosis

Abstract Background MINOCA's physiopathology, treatment and prognosis are yet to be completely understood. The aim of this study is to compare baseline characteristics and prognosis of MINOCA patients and those of patients with myocardial infarction (MI) and obstructive coronary arteries. Methods We analysed all consecutive patients with MI who underwent coronary angiography admitted in a University Hospital covering a population of 220.000 people during a period of 60 months. The database and the all the patient's angiographies were revised by a group of experts in order to adequate MINOCA to 2020 ESC Guidelines definition and the American Heart Association position paper. Results 680 patients, 68 of whom were MINOCA (10%) with a median of follow up of 31±16 months were analysed (see table 1). We found no differences in both groups' age. Female gender was more prevalent among MINOCA patients. The underlying mechanism in MINOCA was coronary spasm (17.6%), plaque rupture (13.2%), coronary embolism (7.4%), coronary dissection (2.9%), type II infarction (19.1%) or unknown (39.7%). Coronary arteries in MINOCA patients had no obstructions at all in 57.4%, and 30–50% obstruction in 42.6% of the cases. MINOCA patients didn't have higher prevalence of cancer, autoimmune or psychiatric diseases, dyslipidaemia, hypertension or inflammatory analytical parameters. However, we found significant differences in atrial fibrillation, migraine, connective tissue diseases, tobacco use and diabetes. We found no effect of stress in the development of MINOCA (measured with validated STAI and DS-14 scales). Symptoms at admission didn't differ between the two groups, but those with MINOCA had normal ECG more frequently. Prognosis showed relevant differences, as MINOCA patients had less major cardiovascular complications, such as inotropic requirements (0% Vs 4.8%, p=0.04), shock (0% vs 6.6%, p=0.013) and left ventricular dysfunction (11.8 vs 30.2, p=0.015). Furthermore, myocardial injury biomarkers' levels were, significantly lower in MINOCA patients. Death rates tend to be lower both in hospital (0% vs 3.1%, p=0.131) and during follow up (9.1% vs 11.5%, p=0.369). Conclusion Analysing MINOCA patients' clinical profile might help us understanding the underlying physiopathology, prognosis and treatment targets. In these patients, classic cardiovascular risk factors don't appear to be as important as in obstructive patients. At admission, we found no clinical differences that could help making an early diagnosis, even if those with normal ECG and lower levels of myocardial injury biomarkers are more likely to have non-obstructive coronary arteries. These patients seem to have better prognosis and lower myocardial injury than those with obstructive coronary arteries. Further research is needed to provide more evidence on the accurate treatment of these patients. Funding Acknowledgement Type of funding sources: None.

The role of cardiac magnetic resonance in MINOCA diagnosis

Abstract Introduction Absence of obstructive coronary disease does not imply absence of acute myocardial infarction (AMI). Hence, it can be designated as Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA). Performing Cardiac Magnetic Resonance (CMR) can be essential for establishing a final diagnosis, according to the presence and pattern of late gadolinium enhancement (LGE). Purpose The aim of this study is to evaluate the diagnostic and prognostic impact of CMR in patients with a possible diagnosis of MINOCA. Methods A 7-year prospective study, which included all patients proposed to CMR with a presumptive diagnosis of MINOCA due to acute chest pain, troponin raise and absence of angiographically significant coronary disease (luminal stenosis of &amp;lt;50%). All patients performed functional, anatomical evaluation and LGE assessment. We analysed clinical characteristics, electrocardiographic presentation, echocardiographic and invasive coronary angiography results. A presumptive diagnosis was elaborated after invasive coronary angiography and comparison was made with the definitive one after CMR. Results A total of 96 patients were included, 50% were male, with a mean age of 48±20 years old. Clinical history of hypertension was observed in 51.0% patients, 35.4% had dyslipidaemia, 7.3% with diabetes, obesity was present in 22.9% of patients and smoking habits in 30.2%. At admission, 44.8% had ST segment elevation, so emergent invasive coronary angiography was performed. The mean highest troponin I was 7.34±9.18 ng/mL. Late gadolinium enhancement was observed in 53 (55.2%) of patients. After CMR realization a final diagnosis of MINOCA was made in only 8 patients (8.4%) and in 51 patients (53.1%) CMR evaluation allowed a diagnosis modification, with impact on patients' management and prognosis. A definitive diagnosis of myocarditis was seen in 46.9% (n=45) of cases, of Takotsubo's myocardiopathy in 13.5% (n=13), and hypertrophic cardiomyopathy in 3.1% (n=3). In 27 (28.1%) of patients, late gadolinium enhancement was not found. This diagnosis adjustment had an impact on treatment in 34.4% (n=33). Conclusion CMR is a pivotal technique on MINOCA patients' management. Our study portrayed the importance of performing CMR, allowing initial diagnosis modification in half of the cases, with important therapeutic in one third of patients and prognostic implications, related to diagnosis and target treatment adverse effects. Funding Acknowledgement Type of funding sources: None.

Anxiety in MINOCA patients according to latest definitions

Abstract Background Anxiety is a global public health problem affecting the lives of large numbers of patients (pts) and their families. Some studies suggest that pts with MINOCA (myocardial infarction with non-obstructive coronary arteries) have more anxiety levels than the rest of pts with myocardial infarction (MI). The aim of this study is to compare anxiety levels between pts with MINOCA and the rest of MI pts using a validated scale: The State Trait Anxiety Inventory (STAI). Methods An analytical and observational study was developed in a University Hospital. We analysed the clinical data of all consecutive MI pts admitted to our centre from July 2017 to December 2020. Inclusion criteria were determined by the 4th Universal Definition of Myocardial Infarction and the latest definitions of MINOCA according to the 2020 ESC Guidelines. A group of experts reviewed all MINOCA cases in order to exclude those who did not fulfil the selection standards and takotsubo syndrome and myocarditis pts were excluded. STAI questionnaire was completed by each patient during admission. Data collected included “trait anxiety”, that refers to relatively stable individual differences in anxiety-proneness, whereas “state anxiety” is a temporary emotion due to a particular situation (hospitalization in this case). Total score in each subgroup ranges from 0 to 60 points, where a higher score correlates with major anxiety levels. Follow up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke and death from any cause). Survival analysis is based on Cox regression. Median follow-up was 25±23 months. Results From a total of 413 consecutive MI pts, 243 (58.8%) completed the questionnaire. Of them, 32 (13%) were MINOCA pts. There were no significant differences in trait anxiety between both groups (MINOCA mean value 21±14 points vs rest of MI 19±10 points, p=0.9), nor in state anxiety (20±14 vs 19±10 points, p=0.8). There were also no significant differences when data were analysed by percentiles: 37.5% of MINOCA pts were below P25 and 28% of the rest of MI were also in this percentile. At the other end of the scale, 31.3% of MINOCA pts were above P75, as well as 22.7% of the rest of MI pts (table 1). During follow up, punctuation in trait anxiety in MINOCA pts showed no differences in MACE (HR 1.01, CI 95% (0.9–1.07)), nor did punctuation in state anxiety (HR 1.01, CI 95% (0.9–1.06)). This was also observed in the rest of MI pts: trait anxiety HR 1.01, CI 95% (0.9–1.04) and state anxiety HR 0.9, CI 95% (0.9–1.01). Conclusion In this study, there were no significant differences in anxiety levels between MINOCA pts and the rest of MI pts. The lack of takotsubo pts in this study reflect real data from MINOCA according to the latest definitions. Subjective emotions could lead to mistaken findings, making it necessary to determine emotional disorders with validated and objective tools. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): European Society of Cardiology Table 1. Percentile values of STAI.

Role of inflammation in Myocardial Infarction with Non-Obstructive Coronary Arteries

Abstract Background The characteristics of patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) differ from those with Myocardial Infarction with Obstructive Coronary Artery Disease (MI-CAD). Thus, the mechanisms involved, such as inflammation, may be different. The objective of this study is to analyze the relationship between pro-inflammatory conditions and MINOCA, as well as the impact on their prognosis. Methods An analytical and observational study, including all patients admitted to our hospital with myocardial infarction and who underwent coronary angiography in the last four years (2016–2020; n=712). According to the definitions of the 2019 AHA Scientific Statement on Diagnosis and Management of MINOCA and ESC 2020 guidelines on Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation, we classified the patients into two groups: MI-CAD (n=643) and MINOCA (n=69). Besides general data, we recorded specific information about pro-inflammatory conditions (prevalence of autoimmune diseases, connective tissue disorders, and active infections and neoplasms). We also assessed C-reactive protein (C-RP) at admission, peak CK-MB and troponin levels. Follow-up analysis included death from any cause, major adverse cardiac events (MACE: cardiac death, MI, stroke), readmissions due to cardiovascular causes, and in-hospital mortality. Results The composite of pro-inflammatory conditions (autoimmune pathologies, connective tissue diseases and active cancer and infections) was significantly higher in the MINOCA group (30.4% vs 14.6%, p&amp;lt;0.001). Patients with MINOCA had higher rates of connective tissue disorders (5.8% vs 1.4%, p 0.01), and autoimmune diseases (14.5% vs 7.8%, p 0.058) tended to be more frequent in these patients. However, MINOCA patients had lower C-RP levels (180 vs 206mg/L, p&amp;lt;0.001), probably because they have smaller infarcts (peak CK-MB: 228 vs 325 U/L, p&amp;lt;0.001; high-sensitivity cardiac troponin T levels: 111 vs 176ng/L, p&amp;lt;0.001). In the follow-up of MINOCA patients, MACE did not occur more frequently in those patients with inflammatory conditions (4.8% vs 13%, p 0.3) than those without them. Moreover, pro-inflammatory disorders were not related to significantly higher mortality from any cause (8.7% vs 10%, p 0.86) nor readmissions due to cardiovascular causes (19.6% vs 23.8%, p 0.6). Our median follow-up was 29 months. There were no differences in in-hospital mortality. Conclusion This study suggests that pro-inflammatory disorders may be a risk factor for developing MINOCA without resulting in an unfavourable short- and long-term prognosis. Further research is needed to confirm this finding and identify its optimal management. Funding Acknowledgement Type of funding sources: None.

Differences between Takotsubo and the working diagnosis of myocardial infarction with non-obstructive coronary arteries

Abstract Aims Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCA) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCA. Methods and results A cohort study based on two prospective registries: TTS from the XXXX1 registry (N:1055) and non-TTS MINOCA patients from contemporary records of acute myocardial infarction from 5 national centers (N:1080). Definitions and management recommended by the ESC were used. Survival analysis was based on Cox regression; propensity score matching was created to adjust prognostic variables. TTS were more often women (85.9% vs. 51.9%; p&amp;lt;0.001) and older (69.4±12.5 vs. 64.5±14.1 years; p&amp;lt;0.001). Atrial fibrillation was more frequent in non-TTS MINOCA (10.4% vs. 14.4%; p 0.007). Psychiatric disorders were more prevalent in TTS (15.5% vs. 10.2%, p&amp;lt;0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs 1.8%, (p 0.015) and 25.8% vs. 11.5%, (p&amp;lt;0.001). Median follow-up was 32.4 months; TTS had less major adverse cardiovascular events (MACE): Hazard Ratio (HR) 0.59; 95% confidence interval (CI) 0.42 to 0.83. There were no differences in global mortality (HR 0.87; CI: 0.64 to 1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35 to 0.98). Conclusions Compared to the rest of MINOCA, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis. Funding Acknowledgement Type of funding sources: None. Central Illustration