Role of cardiovascular magnetic resonance in the prognosis of patients with myocardial infarction with non-obstructive coronary arteries

Abstract Background It is estimated that 5% to 10% of patients with myocardial infarction (MI) present with no obstructive coronary artery lesions. Until now, most studies have focused on acute coronary syndrome, including different clinical entities with a similar presentation encompassed under the term MINOCA (MI with non-obstructive coronary arteries). The aim of this study is to assess the prognosis of patients diagnosed with true infarction, confirmed by cardiovascular magnetic resonance (CMR), in the absence of significant coronary lesions. Methods Prospective multicenter registry study, including 120 consecutive patients with a CMR-confirmed MI without obstructive coronary artery lesions. The primary clinical outcome was major adverse cardiovascular events (MACE: death, non-fatal infarction, stroke, or cardiac readmission), assessed over three years. Results Seventy-six patients (63.3%) were admitted with a diagnosis of acute coronary syndrome, and 44 (36.6%) for other causes (mainly heart failure); the definitive diagnosis was established by CMR. Most patients (64.2%) were men, and the mean age was 58.8 ± 13.5 years. Patients presented with small infarcts: 83 (69.1%) showed late gadolinium enhancement (LGE) in one or two myocardial segments, mainly transmural (in 77.5% of patients) and with a preserved left ventricular ejection fraction (median 54.8%, interquartile range 37–62). The most frequent infarct location was inferolateral (n = 38, 31.7%). During follow-up, 43 patients (35.8%) experienced a MACE, including 9 (7.5%) who died. In multivariable analysis, LGE in two versus one myocardial segment doubled the risk of adverse cardiac events (hazard ratio [HR] 2.32, 95% confidence interval [CI] 0.97–5.83, p = 0.058). Involvement of three or more myocardial segments almost tripled the risk (HR 2.71, 95% CI 1.04–7.04, p = 0.040 respectively). Conclusions Patients with true MI but without significant coronary artery lesions predominantly had small infarcts. Myocardial 3-segment LGE involvement is associated with a significantly higher risk of adverse cardiac events.

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Acute One-Stop Cardiovascular Magnetic Resonance Imaging for Differential Diagnosis in Patients with Acute Coronary Syndrome and Unobstructed Coronary Arteries

Medical Principles and Practice ◽

10.1159/000381856 ◽

2015 ◽

Vol 24 (4) ◽

pp. 325-331 ◽

Cited By ~ 1

Author(s):

Guang Chu ◽

Guobing Zhang ◽

Ming Zhu ◽

Zhi Zhang ◽

Ying Wu ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Acute Coronary Syndrome ◽

Differential Diagnosis ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Coronary Arteries ◽

Cardiovascular Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Coronary Syndrome ◽

One Stop

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Abstract 2602: Elevated Serum Neopterin Levels and Adverse Cardiac Events in Patients with Non-ST-Segment Elevation Acute Coronary Syndrome

Circulation ◽

10.1161/circ.116.suppl_16.ii_576-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Juan Carlos Kaski ◽

Luciano Consuegra-Sanchez ◽

Daniel J. Fernandez-Berges ◽

Jose M Cruz-Fernandez ◽

Xavier Garcia-Moll ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Unstable Angina ◽

Elevated Serum ◽

Cardiac Events ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Adverse Cardiac Events ◽

Elevation Acute Coronary Syndrome

Objectives: We sought to assess whether plasma neopterin predicts adverse clinical outcomes in patients with NSTEACS. Background: Circulating C reactive protein (CRP), a marker of inflammation, correlates with events in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). High neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients but their prognostic role in NSTEACS has not been systematically evaluated. Methods: We prospectively assessed 397 patients (74 % men) admitted with NSTEACS: 169 (42.5%) had unstable angina and 228 (57.5%) non-ST-segment elevation myocardial infarction (NSTEMI). Blood samples for neopterin and CRP assessment were obtained at admission. TIMI risk score was also assessed among other clinical and biochemical variables. The study end point was the composite of cardiac death, acute myocardial infarction and recurrent angina at 180-days. Results: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.5–10.6] vs 8.0 [6.2–11.1], p = 0.54). Fifty-nine patients (14.9 %) had events during follow-up (highest third (%) 21.5 vs 1 st and 2 nd thirds 11.5, log rank 7.341, p = 0.007). On multivariable hazard Cox regression, only neopterin (highest vs 1 st and 2 nd thirds, HR 2.15, 95 % CI [1.21–3.81]) was independently associated with the combined endpoint.CRP levels, however, were not significantly different in patients with events compared to those without events (adjusted HR = 0.98, p = 0.89, 95% CI 0.80 –1.21). Conclusion: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in patients with NSTEACS.

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Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

Journal of Dhaka National Medical College & Hospital ◽

10.3329/jdnmch.v18i2.16024 ◽

2013 ◽

Vol 18 (2) ◽

pp. 52-57 ◽

Cited By ~ 1

Author(s):

Mohammad Abul Ehsan ◽

Md Manzoor Mahmood ◽

Laila Farzana Khan ◽

Md Abu Salim

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Index ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

St Elevation ◽

Group 1

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 0%, 3.7%, 12.9% & 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 4.7%, 12.5%, 17.1% & 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

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Myocardial infarction or acute coronary syndrome with non-obstructive coronary arteries and sudden cardiac death: a missing connection

EP Europace ◽

10.1093/europace/euaa156 ◽

2020 ◽

Vol 22 (9) ◽

pp. 1303-1310

Author(s):

Nikolaos Kosmas ◽

Antonis S Manolis ◽

Nikolaos Dagres ◽

Efstathios K Iliodromitis

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Coronary Artery ◽

Sudden Cardiac Death ◽

Coronary Arteries ◽

Cardiac Death ◽

Large Scale ◽

Artery Dissection ◽

Atheromatous Plaque ◽

Coronary Syndrome

Abstract Myocardial infarction with non-obstructive coronary arteries or any acute coronary syndrome (ACS) with normal or near-normal (non-obstructive) coronary arteries (ACS-NNOCA) is an heterogeneous clinical entity, which includes different pathophysiology mechanisms and is challenging to treat. Sudden cardiac death (SCD) is a catastrophic manifestation of ACS that is crucial to prevent and treat urgently. The concurrence of the two conditions has not been adequately studied. This narrative review focuses on the existing literature concerning ACS-NNOCA pathophysiology, with an emphasis on SCD, together with risk and outcome data from clinical trials. There have been no large-scale studies to investigate the incidence of SCD within ACS-NNOCA patients, both early and late in the disease. Some pathophysiology mechanisms that are known to mediate ACS-NNOCA, such as atheromatous plaque erosion, anomalous coronary arteries, and spontaneous coronary artery dissection are documented causes of SCD. Myocardial ischaemia, inflammation, and fibrosis are probably at the core of the SCD risk in these patients. Effective treatments to reduce the relevant risk are still under research. ACS-NNOCA is generally considered as an ACS with more ‘benign’ outcome compared to ACS with obstructive coronary artery disease, but its relationship with SCD remains obscure, especially until its incidence and effective treatment are evaluated.

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Fully Automated Cardiac Assessment for Diagnostic and Prognostic Stratification Following Myocardial Infarction

Journal of the American Heart Association ◽

10.1161/jaha.120.016612 ◽

2020 ◽

Vol 9 (18) ◽

Cited By ~ 1

Author(s):

Andreas Schuster ◽

Torben Lange ◽

Sören J. Backhaus ◽

Carolin Strohmeyer ◽

Patricia C. Boom ◽

...

Keyword(s):

Artificial Intelligence ◽

Myocardial Infarction ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Intraclass Correlation ◽

Area Under The Curve ◽

Left Ventricular ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Adverse Cardiac Events

Background Cardiovascular magnetic resonance imaging is considered the reference methodology for cardiac morphology and function but requires manual postprocessing. Whether novel artificial intelligence–based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of artificial intelligence–based, commercially available software analyses. Methods and Results Cardiovascular magnetic resonance data (n=1017 patients) from 2 myocardial infarction multicenter trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and artificial intelligence–based software. Obtained parameters entered regression analyses for prediction of major adverse cardiac events, defined as death, reinfarction, or congestive heart failure, within 1 year after the acute event. Both manual and uncorrected automated volumetric assessments showed similar impact on outcome in univariate analyses (left ventricular EF, manual: hazard ratio [HR], 0.93 [95% CI 0.91–0.95]; P <0.001; automated: HR, 0.94 [95% CI, 0.92–0.96]; P <0.001) and multivariable analyses (left ventricular EF, manual: HR, 0.95 [95% CI, 0.92–0.98]; P =0.001; automated: HR, 0.95 [95% CI, 0.92–0.98]; P =0.001). Manual correction of the automated contours did not lead to improved risk prediction (left ventricular EF, area under the curve: 0.67 automated versus 0.68 automated corrected; P =0.49). There was acceptable agreement (left ventricular EF: bias, 2.6%; 95% limits of agreement, −9.1% to 14.2%; intraclass correlation coefficient, 0.88 [95% CI, 0.77–0.93]) of manual and automated volumetric assessments. Conclusions User‐independent volumetric analyses performed by fully automated software are feasible, and results are equally predictive of major adverse cardiac events compared with conventional analyses in patients following myocardial infarction. Registration URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT00712101 and NCT01612312.

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Prospective study one-year clinical outcomes of the Calypso coronary stent in patients presenting with acute coronary syndrome

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-1-44-49 ◽

2017 ◽

Vol 21 (1) ◽

pp. 44 ◽

Cited By ~ 1

Author(s):

V. L. Vorobev ◽

A. A. Semenihin ◽

N. I. Grachev ◽

V. V. Verin

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Conflict Of Interest ◽

Cardiac Death ◽

Target Lesion ◽

Major Adverse Cardiac Events ◽

Cardiac Events ◽

Coronary Syndrome ◽

Adverse Cardiac Events ◽

One Year

Aim. To evaluate the effectiveness of the stent use Calypso Angiolain Russia with primary percutaneous transluminal coronary angioplasty (PTCA). Methods. The study prospectively included 150 patients who underwent PTCA in acute coronary syndrome (ACS) for the period from January to December 2015. During the one-year follow-up period were evaluated indicators insolvency target lesion (cardiac death, myocardial infarction in the pool target artery, target lesion revascularization when clinically indicated), major adverse cardiac events (death from any cause, myocardial infarction, repeat revascularization as clinically indicated). Results. In one year, the incidence of target lesion failure was 6.66% for cardiac death rate of 1.33%, myocardial infarction in the target artery 3.33% and target lesion revascularization at 5.3%. The frequency of cardiac major adverse cardiac events was 12% at mortality 2.66%, myocardial infarction 4% and revascularization when clinically indicated 8.66%. Conclusion. The use of stents in primary PTCA Calypso is possible, the percentage of cardiovascular complications is comparable with the data of clinical trials.Received 31 January 2017. Accepted 17 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

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