Importance of confirming the underlying diagnosis in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA): a single-centre retrospective cohort study

• Published in: BMC cardiovascular disorders 2021-07, Vol.21 (1), p.357-357, Article 357
• Main Authors: Pustjens, T F S, Meerman, A, Vranken, N P A, Ruiters, A W, Gho, B, Stein, M, Ilhan, M, Veenstra, L, Winkler, P, Lux, Á, Rasoul, S, van 't Hof, A W J
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - mortality; Acute coronary syndromes; Adult; Aged; Aortic dissection; Calcium-binding protein; Cardiomyopathy; Cardiovascular disease; Cerebral infarction; Cohort analysis; Coronary artery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary vessels; Creatine; Creatine kinase; Demographic aspects; Diagnosis; EKG; Electronic health records; Emergency medical care; Evaluation; Female; Heart attack; Heart attacks; Heart diseases; Humans; Ischemia; Male; Medical imaging; Medical prognosis; Middle Aged; MINOCA; Myocardial infarction; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Myocarditis; Outcome; Patients; Practice guidelines (Medicine); Predictive Value of Tests; Prevalence; Prognosis; Pulmonary embolisms; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Statistical analysis; Survival analysis; Time Factors; Troponin; Ventricle
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-021-02176-2

Many patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) are discharged without a known aetiology for their clinical presentation. This study sought to assess the effect of this 'indeterminate MINOCA' diagnosis on the prevalence of recurrent cardiovascular events and presentations to the Cardiac Emergency Department (CED). We retrospectively analysed all patients meeting the diagnostic MINOCA criteria presenting at a large secondary hospital between January 2017 and April 2019. Patients were divided into the (1) 'indeterminate MINOCA', or (2) 'MINOCA with diagnosis' group. The primary outcome was the occurrence of major adverse cardiac events (MACE) defined as the composite of all-cause mortality, non-fatal myocardial infarction, stroke and any revascularisation procedure. Secondary outcomes were all recurrent visits at the CED, and MACE including unplanned cardiac hospitalisation. In 62/198 (31.3%) MINOCA patients, a conclusive diagnosis was found (myocardial infarction, (peri)myocarditis, cardiomyopathy, or miscellaneous). MINOCA patients with a confirmed diagnosis were younger compared to those with an indeterminate diagnosis (56.7 vs. 62.3 years, p = 0.007), had higher maximum troponin-T [238 ng/L vs. 69 ng/L, p