P877Comparing the MINOCA and MIOCA patients risk profile and prognosis according to definitions of 2016 ESC position paper
Authors: Cobas Paz R J , Abu-Assi E , Raposeiras Roubin S , Caneiro Queija B , Cespon Fernandez M , Munoz Pousa I , Dominguez Erquicia P , Dominguez Rodriguez L M , Castineira Busto M , Fernandez Barbeira S , Iniguez Romo A 
Published: October 2019

Introduction

MINOCA (myocardial infarction with non-obstructive coronary arteries) has been recently redefined by the last ESC guidelines. The aim of this study is to analyze clinical profile and long-term prognosis of these patients.

Methods

Retrospectively, between 1/2010 and 12/2016 all consecutive patients with the definitive diagnosis of MI in tertiary center were included in this observational study. Patients with unstable angina with non-obstructive coronary artery disease and those who died in-hospital were excluded. Patients were stratified according to the number of significant coronary vessel disease seen by coronary angiography into: 0 (MINOCA); 1; 2; ≥3 vessels. The definition of MINOCA was based on dedicated the 2016 ESC Working Group position paper.

Patients with MINOCA were compared to their counterpounds (MIOCA; MI with obstructive CAD) regarding baseline clinical characteristics, on-admission and laboratory data and treatment at hospital discharge. The prognostic meaning of MINOCA vs MIOCA was ascertained by comparing the composite endpoint (re-ACS, stroke and death) rate among groups, using Kaplan-Meier and multivariate Cox regression analyses.

Results

13.8% (n=597) pts were classified as MINOCA. They were older and more frequently women than the obstructive group. MINOCA group also had a worse cardiovascular risk profile than pts with obstructive coronary lesions. They were associated more frequently with atrial fibrillation during hospitalization (11.2% vs. 6.8%, p<0.01). Peak of troponin I was lower in the MINOCA group [median 12 (IQR: 1.4–42.0 vs 20 (2.3–95.5), p<0.01]. MINOCA pts had more frequently a previous history of depression (34.1% vs 19.3%, p<0.01), and malignancy (9.2% vs. 7.6%, p=0.18).

During 15 months (IQR: 12,3–25,5), 613 (14.2) pts had a new ACS, stroke or died (251 pts developed a new ACS, 81 had stroke, and 281 died). The incidence of the composite endpoint was 4.2% in the MINOCA pts, 4.1% in pts with 1-significant coronary vessel disease, 6.3% in the 2-significant coronary vessel disease, and 9.5% in the ≥3-significant coronary vessel disease (p<0.01) (Figure). After adjusting for age, ACS type, sex, Killip class, age, HTA, DM, stroke, peripheral artery disease, smoking, prior CAD, COPD, prior malignancy, baseline hemoglobin and creatinine values, DES vs BMS, history of atrial fibrillation, and treatment at discharge, and considering MINOCA as a reference group, HR for the composite endpoint was 1.02 (0.60–1.78; p=0.93) for the 1-vessel group, 1.3 (0.7–2.2; p=0.41) for the 2-vessels group, and 1.6 (0.93–2.8; p=0.08) for the ≥3-vessels group.

Figure 1. Composite endpoint

Conclusions

In the present cohort MINOCA was approximately found in one of each 14 patients admitted with MI. These patients had worse CV risk profile and more history of depression. MINOCA pts have similar prognostic impact in terms of hospitalization for a new ACS, stroke and death than the obstructive group.