Characteristics and Prognosis of a Contemporary Cohort with Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) Presenting Different Patterns of Late Gadolinium Enhancements in Cardiac Magnetic Resonance Imaging

• Published in: Journal of clinical medicine 2023-03, Vol.12 (6), p.2266
• Main Authors: Bucciarelli, Valentina, Bianco, Francesco, Francesco, Alessia Di, Vitulli, Piergiusto, Biasi, Annaclara, Primavera, Martina, Belleggia, Sara, Ciliberti, Giuseppe, Guerra, Federico, Seferovic, Jelena, Dello Russo, Antonio, Gallina, Sabina
• Format: Article
• Language: English
• Subjects: Brief Report; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Clinical medicine; Coronary arteries; Coronary vessels; Diabetes; Diagnosis; Edema; Gadolinium; Heart attack; Heart attacks; Hypertension; Laboratories; Magnetic resonance imaging; Medical examination; Medical imaging; Medical prognosis; Medical records; Methods; Myocarditis; Prognosis
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12062266

To analyze the characteristics and prognosis of a contemporary cohort of patients with myocardial infarction with non-obstructed coronaries (MINOCA) were referred for cardiac magnetic resonance (CMR) imaging, focusing on late gadolinium enhancement (LGE) patterns. We retrospectively examined and prospectively followed up with 135 patients (49 ± 21 years old, 48% female) undergoing CMR imaging due to a MINOCA diagnosis from 2014 to 2016. We grouped and analyzed the sample according to ischemic (focal or transmural) and non-ischemic LGE patterns. The primary outcome was cardiac-related death; the secondary outcome was a composite of cardiac-related rehospitalizations, the new occurrence of acute myocardial infarction (AMI), heart failure (HF), or arrhythmias. CMR exams were performed after a median of 28 days from the acute event. One-third of the ischemic MINOCA were first managed as myocarditis, while CMR helped to adopt a different therapy regimen in 22% of patients (30/135). After a median follow-up of 2.3 years, more cardiac-related deaths occurred in the ischemic than non-ischemic group (2 vs. 1, = 0.36), but it was not statistically significant. The ischemic group also experienced more cardiac-related-rehospitalizations (42%, < 0.001). In a multivariable Cox regression model, dyslipidemia, reduced left ventricular ejection fraction, ST-elevation at the hospitalization, and the LGE transmural pattern were the independent predictors of cardiac-related rehospitalizations. In a contemporary cohort of MINOCA patients who underwent CMR, ischemic and non-ischemic patterns had distinct features and outcomes. Among the MINOCA patients, CMR can identify patients at higher risk who require more aggressive therapeutic approached and strict follow-up.