Results of a six-year prospective study of surgical treatment of patients with combined atherosclerosisof coronary and brachiocephalic arteries based on differentiated approach

Objective. To present the results of surgical treatment of patients with multifocal atherosclerosis based on a differential approach of surgical strategy. Materials and methods. During the period of 20142021 in the S.G. Sukhanov Federal Center for Cardiovascular Surgery, Perm, we operated 243 patients with combined atherosclerosis of coronary and carotid arteries; 104 (42.8 %) patients underwent a one-stage coronary and carotid artery surgeries, and 139 (57.2 %) patients underwent a staged correction of pathology. Critical lesion of the coronary arteries was revealed in 16 (6.6 %) patients, single-vessel critical lesion in 24 (9.9 %), two-vessel and three-vessel critical lesion was detected in 87 (35.8 %) and 79 (32.5 %) patients, respectively. 145 (59.7 %) patients had a critical lesion of the carotid arteries, and 16 (6.58 %) had a bilateral critical lesion. We have developed an algorithm for choosing treatment tactics in patients with concomitant atherosclerotic lesions of the coronary and carotid arteries. Depending on our differential approach, we selected 104 (42.8 %) patients who underwent a one-stage surgery, and 139 (42.8 %) patients who were subjected to a staged treatment. Results. A total hospital mortality was 0 %. In the staged group, 1 case of transitory ischemic attack (TIA) (0.7 %) was recorded, in the group of combined interventions there was no TIA. In the group of combined interventions, there were 3 (2.9 %) cases of the perioperative stroke and 1 (0.9 %) case of myocardial infarction. In the group that underwent staged interventions, there were 2 (1.4 %) cases of perioperative stroke and 2 (1.4 %) cases of myocardial infarction. Both groups had similar combined results (death, acute MI, stroke) 5 (3.6 %) for the staged group and 4 (3.8 %) for the combined one. There was no significant difference in any of the endpoints. Conclusions. The proposed approach to the choice of techniques for treatment of combined lesions of the carotid and coronary arteries based on the differential approach is safe and permits to adequately eliminate the lesions.

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Hybrid technologies in surgical treatment of patients with concomitant atherosclerotic lesions of carotid and coronary arteries

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-1-45-53 ◽

2015 ◽

Vol 17 (1) ◽

pp. 45 ◽

Cited By ~ 4

Author(s):

A. M. Chernyavskiy ◽

M. A. Chernyavskiy ◽

T. Ye. Vinogradova ◽

A. G. Yedemskiy

Keyword(s):

Surgical Treatment ◽

Coronary Arteries ◽

Carotid Arteries ◽

Rapid Development ◽

Peripheral Arteries ◽

Endovascular Techniques ◽

Hybrid Procedures ◽

Atherosclerotic Lesions ◽

Hybrid Technologies ◽

Revascularization Surgery

Cardiovascular diseases, which have their origins in atherosclerosis, are the "leaders" in morbidity and mortality among the population in many countries. Given the increase of elderly people in the population, it is important to choose the best strategy for surgical treatment of patients with combined atherosclerotic lesions of several arteries (coronary arteries, carotid arteries, peripheral arteries of the lower extremities, atherosclerosis visceral branches of the abdominal aorta). Currently, there is yet no common approach to the timing and sequence of revascularization surgery in this group of patients. The rapid development of endovascular techniques enables us to carry out the so-called hybrid procedures in patients with atherosclerotic lesions of several arteries. In this article we analyze different strategies that are used to manage patients with both coronary and carotid arteries atherosclerotic lesions.

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588 Prognostic impact of early vs. deferred angiography in MINOCA patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suab140.045 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Matteo Armillotta ◽

Angelo Sansonetti ◽

Sara Amicone ◽

Francesco Angeli ◽

Michele Fabrizio ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Angiography ◽

Coronary Arteries ◽

Optimal Timing ◽

Prognostic Impact ◽

Invasive Strategy ◽

St Segment Elevation ◽

St Segment ◽

Significant Difference ◽

All Cause Mortality

Abstract Aims Although an early invasive strategy (coronary angiography performed <24 h) is associated with a lower risk of recurrent/refractory ischaemia among patients with acute myocardial infarction (AMI) and obstructive coronary arteries, the optimal timing of invasive examination in patients with non-obstructive coronary arteries and non-ST-segment elevation presentation (NSTE-MINOCA) has not been explored. This study tested the hypothesis that, compared to early (<24 h) invasive strategy, deferred (≥24 h) coronary angiography has equivalent prognostic impact in patients with NSTE-MINOCA. Methods and results From 2016 to 2020, all consecutive MINOCA patients diagnosed according to the current ESC diagnostic criteria (angiographic conventional cut-off of < 50% coronary stenosis without a clinically apparent alternative diagnosis) and admitted to our Centre with non-ST-segment elevation myocardial infarction (NSTEMI) presentation were enrolled. Very high-risk NSTEMI patients have been excluded from the study. The prognostic value of an early (<24 h) vs. deferred (≥24 h) coronary angiography was assessed. All-cause mortality and a composite endpoint of all-cause mortality, stroke, re-hospitalization for heart failure, and myocardial re-infarction were evaluated. 198 NSTE-MINOCA patients were enrolled. MINOCA patients were more frequently females (64%) and the mean age was 68.6 ± 13.2 years. The median follow-up time was 26 (14–40) months. The total number of events was 54 (27.3%). Kaplan–Meier curves showed that there was no statistically significant difference (P = 0.88) between the two study groups depending on the time of invasive strategy adopted. Specifically, the rates of death (15% vs. 11.3%) and MACEs (28.3% vs. 25%) were similar in MINOCA patients undergoing early vs. deferred angiography. Conclusions We demonstrate for the first time that in the MINOCA population the prognosis was not influenced by an early vs. deferred coronary angiography, unlike in AMI patients with obstructive coronary arteries. These results add another piece to the puzzle and pave the way for the initial use of a non-invasive imaging strategy (e.g. Coronary-CT), mostly in patients with NSTEMI and high clinical suspicion of non-obstructive coronary arteries.

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

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.807494 ◽

2021 ◽

Vol 8 ◽

Author(s):

Side Gao ◽

Haobo Xu ◽

Sizhuang Huang ◽

Jiansong Yuan ◽

Mengyue Yu

Keyword(s):

Myocardial Infarction ◽

Coronary Arteries ◽

Cox Regression ◽

Randomized Study ◽

Similar Efficacy ◽

Major Adverse Cardiovascular Events ◽

Efficacy And Safety ◽

Bleeding Events ◽

Coronary Syndrome ◽

Significant Difference

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.

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Myocardial infarction caused by non-atherothrombotic lesion of carotid arteries

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2016-94-11-809-812 ◽

2017 ◽

Vol 94 (11) ◽

pp. 809-812

Author(s):

Lyudmila V. Popova ◽

T. V. Khlevchuk ◽

M. B. Axenova

Keyword(s):

Myocardial Infarction ◽

Coronary Arteries ◽

Carotid Arteries ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment ◽

Microvascular Spasm ◽

The Difference ◽

Spontaneous Dissection

Atherothrombosis is not the sole cause of myocardial infarction (MI). The clinical picture of MI of different origin is similar to the classical one. At the same time, coronaroangiography reveals changes in coronary arteries of patients with MI without atherosclerotic obstruction varying from totally intact vessels to atherosclerosis responsible for their 50% narrowing. MI without atherosclerotic obstruction is rarely encountered in clinical practice but regularly occurs in patients with acute coronary syndrome. Atherosclerotic obstruction was absent in 9-10% of the women and 7-8% of men with IM and ST segment elevation. Coronaroangiography demonstrated similar changes in women having MI without ST segment elevation. Men with the same condition exhibited atherosclerotic obstruction only in 4-7% of the cases. Unstable angina was associated with an enhanced frequency of unaffected coronary arteries which increased the difference between the two sexes. MI without atherosclerotic obstruction may be caused by a spasm of coronary arteries, eccentrically located plaques, Takotsubo syndrome, microvascular spasm, myocarditis caused by PVB19 virus, coronary embolism, thrombophilia, spontaneous dissection of coronary arteries, and their abnormalities. Patients having MI without atherosclerotic obstruction require evaluation of the risk of therapy on an individual basis.

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Myocardial bridge and coronary artery fistulas in a patient with angina

Pediatrician (St Petersburg) ◽

10.17816/ped102137-141 ◽

2019 ◽

Vol 10 (2) ◽

pp. 137-141

Author(s):

Aleksandra A. Kholkina ◽

Yuriy R. Kovalev ◽

Vladimir A. Isakov ◽

Natal’ya O. Gonchar

Keyword(s):

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Surgical Treatment ◽

Angina Pectoris ◽

Coronary Angiography ◽

Coronary Arteries ◽

Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

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Abstract P202: Prevalence, Factors, And Long-Term Outcomes Associated With Myocardial Infarction With Non-Obstructive Coronary Artery (MINOCA) Diagnosis In A Large Rural Health Care System Cohort

Circulation ◽

10.1161/circ.141.suppl_1.p202 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Katlin Schmitz ◽

Catherine P Benziger

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Cardiac Rehabilitation ◽

Coronary Arteries ◽

False Positive ◽

Unknown Etiology ◽

Artery Dissection ◽

High Morbidity ◽

Coronary Syndrome ◽

Significant Difference

Hypothesis: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a common cause of false positive (FP) ST-segment elevation myocardial infarction (STEMI) with associated high morbidity and mortality. Background: MINOCA is an important clinical problem found in patients presenting with acute coronary syndrome. Various clinical disorders lead to a working MINOCA diagnosis and make treatment and diagnosis a challenge for clinicians. MINOCA was recently defined by the American Heart Association (AHA) as those presenting with myocardial infarction with nonobstructive coronary arteries on angiography and no alternative diagnoses for presentation. Methods: Between 5/01/2009 -6/24/2019, all consecutive STEMI patients were prospectively examined and categorized into true positive STEMI activations or false positive STEMI activations (FP-STEMI). FP- STEMI were further categorized into groups based on the presence or absence of obstructive coronary arteries by angiography. Results: We had 472 FP-STEMI patients (42.3% female, median age of 58.9±16.9 years, 53.4% lived rurally) with 152 (31.4%) having evidence of coronary artery stenosis >50%. A secondary cause was identified for an additional 162 (34.3%) patients. Of the remaining FP-STEMI, 82 (2.9%) met criteria for MINOCA and 76 (2.6%) were borderline MINOCA due to not meeting the troponin criteria. Within the MINOCA group, the three most common presentations were: unknown etiology (42.7%), supply-demand mismatch (26.8%), and spontaneous coronary artery dissection (17.1%). The MINOCA group had a higher baseline incidence of dyslipidemia (p=0.037) compared to FP-STEMI and borderline MINOCA and lower smoking compared to borderline MINOCA (p=0.029). At discharge, referral to cardiac rehabilitation was lower (p=0.015) with only 69.7% of MINOCA patients having prescriptions for aspirin, 50% angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 64.5% beta blockers, and 65.8% statins. MINOCA had the highest statin prescription rate compared to borderline MINOCA and secondary (65.8% vs 51% vs 42.1%; respectively p=0.012). There was no significant difference between the mortality of MINCOA patient compared to the FP-STEMI patients. Only 10 (3.5%) had cardiac magnetic imaging studies obtained within 6 months (MINOCA 3.9%, borderline MINCOA 3.9%, and FP-STEMI 2.7% respectively). MINOCA patients had similar 30-day and 1-year mortality to FP-STEMI patients (9.0% vs 12.4% and 12.5% vs 15.2 % 30-day and 1-year respectively; p=0.064 and p=0.107). Conclusion: MINOCA represents a challenging group of patients with high mortality and low rates of medication prescription and cardiac rehabilitation referral.

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Evaluation of endothelial function, of elasticity of vessel wall and their influence on one-year prognosis of patients with myocardial infarction with obstructive and non-obstructive coronary arteries

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020284488-496 ◽

2020 ◽

Vol 28 (4) ◽

pp. 488-496

Author(s):

Olga Fomina ◽

Sergey Stepanovich Yakushin

Keyword(s):

Myocardial Infarction ◽

Endothelial Function ◽

Coronary Arteries ◽

Vessel Wall ◽

Augmentation Index ◽

Study Groups ◽

Morphological Alterations ◽

Significant Difference ◽

One Year ◽

The One

Aim. To carry out comparative analysis of the state of the endothelial function (EF), elasticity of the vessel wall and their influence on one-year prognosis of patients with myocardial infarction (MI) with obstructive and non-obstructive coronary arteries (CA). Materials and Methods. In the first stage, 206 patients were selected diagnosed with MI, of them 103 patients with MI with non-obstructive CA (MINOCA) according to the results of coronaroangiography, and 103 patients with MI with obstructive CA (MIOCA). Using the method of random numbers, 59 patients were selected (34 patients of the first group and 25 of the second group), in whom EF and elastic properties of the arterial wall were evaluated. Patients of both groups were initially comparable in age, gender, clinical and anamneustic characteristics, and also in frequency of application of the main groups of medical drugs that influence prognosis. One-year prognosis of the two groups of patients was studied depending on the presence/absence of functional and morphological alterations of the vessel wall. Results. In evaluation of EF in patients MINOCA, the occlusion index by amplitude (OIA) below threshold values was recorded in 22 of 34 (64.7%) cases of MINOCA and in 22 of 25 (88.0%, р0.05) cases of MIOCA. Here, the average values of OIA were 1.7 (1.5; 2.3) and 1.4 (1.2; 1.8), respectively (р0.05). The values of phase shifts between the channels below the norm were equally frequent in two groups (88.2 and 88.0%, р0.05), and comparison of the average values of this parameter did not show any statistically significant difference. The calculated augmentation index normalized to the pulse rate 75 beats per minute (AIp75), in the study groups was 12.5 (9.9; 17.9) and 18.8 (12.9; 20.8), respectively (р0.05). Reduction of the elasticity of the vessel wall in the group with MINOCA was noted in 82.4% of patients, in the group MIOCA in 100% of cases (р0.05). No statistically significant differences were found in the frequency of cardiovascular events between the groups during a year (р0.05). Conclusion. Functional alterations of the vessel wall (endothelial dysfunction and reduction of elasticity of the vessel wall) in patients with MINOCA were recorded almost in 2/3 of cases, however, their incidence in MIOCA was still higher (88.0%). The one-year prognosis in the study groups MINOCA and MIOCA showed no differences.

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P817Shall takotsubo syndrome be tear apart from the working diagnosis of myocardial infarction with non-obstructive coronary arteries?

European Heart Journal ◽

10.1093/eurheartj/ehz747.0416 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Lopez Pais ◽

B Izquierdo Coronel ◽

D Galan Gil ◽

B Alcon Duran ◽

M J Espinosa Pascual ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Arteries ◽

Cox Regression ◽

Systolic Dysfunction ◽

Clinical Profile ◽

University Hospital ◽

Major Adverse Cardiovascular Events ◽

Takotsubo Syndrome ◽

Significant Difference

Abstract Background There is controversy to whether Takotsubo Syndrome (TTS) should be classified as a Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). The aim of this study is to compare the clinical profile and prognosis of TTS with non-TTS MINOCA patients. Methods Analytical and observational study developed in a University Hospital, which covers 220.000 individual. We analyzed the clinical data of all consecutive MINOCA patients admitted to our center during a 3 years period (2016–2018). We used the definitions and the clinical management of 2016 ESC Working Group Position Paper on MINOCA, which considers TTS as a MINOCA. Follow up analysis included death from any cause and major adverse cardiovascular events (MACE). Survival analysis is based on Cox regression. Median follow-up was 17 months. Results Twenty-six out of 109 patients (24%) classified as MINOCA where TTS. Patients with TTS were older (72.2±11.5 vs 62.3±14.9, p<0.01) and the female proportion was higher (72.0 vs 43.9%, p 0.01) than in the non-TTS MINOCA group. Regarding cardiovascular risk factors, there were no significant differences: Hypertension (56.0 vs 63.4%), Dyslipidemia (48.9 vs 45.7%), smoking rate (41.7 vs 41.8%) and diabetes (32.0 vs 22.0%,). The antecedent of atrial fibrillation tended to be higher in TTS group (4.0 vs 18.3%, p 0.08). TTS patients at admission referred angina as the main symptom in fewer cases (56.0 vs 78.0%, p 0.03), but they had an electrocardiogram suggesting ischemia more frequently (87.5 vs 53.7%, p<0.01). TTS presented more frequently with Killip class worse than II (24.9 vs 1.2%, p<0.01) and with more systolic dysfunction (92.0 vs 15.9%m p<0.01) than non-TTS MINOCA. There was no significant difference in the peak of troponin (5.7±9.7 vs 5.6±8.8). Levels of hemoglobin at the admission were lower in the TTS group (12.4±2.2 vs 13.8±2.0, p<0.01). The proportion of in-hospital complications (recovered cardiac arrest, shock, pulmonary edema, ictus, re-infarction) were higher in the TTS group (40.0 vs 6.1%, p<0.01). TTS was an intercurrent complication during admission for a non-cardiovascular pathology in more occasions than non-TTS MINOCA (16 vs 4.9%, p 0.06). During follow-up, TTS showed worse prognosis, with higher all-cause mortality: 16.0 vs 4.0%, Hazard Ratio (HR) 4.49 (Confidence Interval [CI] 1.01–20.10, p<0.05); a tendency to more cardiovascular mortality: 8.0 vs 1.2%, p 0.07, HR 6.7 (CI 0.61–74.35, p 0.12) and to an excess of MACE: 20.0 vs 8.0%, p 0.1, HR 3.1 (CI 0.92–9.98, p 0.07). Conclusion There are differences in the clinical profile and prognosis of TTS patients compared to the rest of non-TTS MINOCA, being TTS a more aggressive entity. We think these data are in line with the recently released 4th Universal Definition of Myocardial Infarction, where TTS should be considered apart from the rest causes of “myocardial injury” or “myocardial infarction”, being an entity with its own characteristics and prognosis.

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Coronary blood flow in myocardial infarction with nonobstructive coronary arteries

European Heart Journal ◽

10.1093/ehjci/ehaa946.1802 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Magnani ◽

S Toniolo ◽

A Rinaldi ◽

P Paolisso ◽

E.C D'Angelo ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Flow ◽

Coronary Artery ◽

Coronary Arteries ◽

Clinical Characteristics ◽

Coronary Perfusion ◽

Slow Flow ◽

Flow Phenomenon ◽

Number Of Patients ◽

Significant Difference

Abstract Background Myocardial infarction (MI) is mainly caused by atherosclerotic plaque thrombosis but several registries show that in 1–13% of cases MI occurs in the absence of obstructive coronary artery disease (MINOCA) utilizing the conventional cut-off of <50% stenosis. MINOCA is generally related to coronary arteries abnormalities (epicardial or microvascular dysfunction – MINOCA-co). However, non-coronary conditions may underlie MINOCA as a consequence of supply-demand mismatch (MINOCA-nco). The TIMI flow gradient (TFG) and the corrected TIMI frame count (CTFC) are established methods able to respectively provide a qualitative and semiquantitative estimation of epicardial blood flow at rest. No studies have yet evaluated these indices in patients with MINOCA. Purpose To evaluate the clinical characteristics of patients with MINOCA and the angiographic indices in MINOCA-co versus MINOCA-nco. Methods Among all consecutive patients undergoing coronary angiogram at our Centre for MI based on the 4th Definition of Myocardial Infarction, the ones showing <50% coronary artery stenosis were retrospectively analyzed; patients with previous coronary stenting were excluded from the study. According to the presence or absence of pre-specified criteria of supply-demand mismatch (SAP >180 mmHg, DAP >110 mmHg, HR >110 bpm, Hb <6 gr/dl, SatO2 <91% or P/F ratio <300), the study cohort was divided into MINOCA-nco and MINOCA-co, respectively. We defined as slow flow phenomenon a TFG < = 2 and/or a CTFC >40 for the left anterior descending artery, >27 for the right coronary artery and >24 for the left circumflex. Results 453 patients were retrospectively evaluated and 112 (24.7%) met the inclusion criteria. Mean age was 68±13.2 years and 41 (36.6%) were males. MINOCA-co was the more prevalent entity accounting for 73 (65.2%) patients while 39 (34.8%) were MINOCA-nco. The two subgroups presented similar baseline characteristics with regards to gender and classic cardiovascular risk factors including hypertension, hypercholesterolemia, diabetes and smoking habit. Peripheral vasculopathy was more prevalent in MINOCA-nco patients (MINOCA-nco=15.4% vs. MINOCAco= 4.2%; p=0.04). Regarding the angiographic indices, there was no statistically significant difference in TFG between subgroups; conversely, the number of patients with a slow flow phenomenon as defined by CTFC was significantly higher in the MINOCA-nco group (MINOCAnco= 25.7% vs. MINOCA-co=9.8%; p=0.039). Conclusions Our data suggest that among patients with MINOCA clinical characteristics were not useful in differentiating between the two disease entities (MINOCA-nco vs. MINOCA-co). However, MINOCA-nco patients had higher coronary flow impairment as evaluated by CTFC. The pathophysiological reason is still not clear; we hypothesized that, in this clinical setting, an increased heart rate, systemic arterial pressure or low oxygen supply might worsen unbalanced coronary perfusion. Funding Acknowledgement Type of funding source: None

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Sex and age differences in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA): presentation and outcome

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.093 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

MGL Williams ◽

A Dastidar ◽

K Liang ◽

TW Johnson ◽

A Baritussio ◽

...

Keyword(s):

Myocardial Infarction ◽

Age Differences ◽

Coronary Arteries ◽

Risk Of Death ◽

Funding Sources ◽

Tertiary Centre ◽

Significant Difference ◽

All Cause Mortality ◽

The Impact ◽

Sex And Age Differences

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is an increasingly recognised working diagnosis. Sex and age differences in MINOCA are not well understood. Purpose This study aims to evaluate the impact of sex and age in patients with MINOCA due to ischaemic and non-ischaemic causes on clinical presentation and outcome. Methods and Results Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality. CMR was performed at a median time of 30 days after presentation and identified a diagnosis in 74% of patients. Men were more likely to have a non-ischaemic cause on CMR (55% v. 41%, p < 0.001) and less likely to have a normal/non-specific scan (21% v. 32%, p = 0.001, figure 1). All-cause mortality was 9.5% over a median follow up of 4.9 years, with no significant difference between sexes (8.7% versus 10.1% p = 0.456). Age group (HR 1.61, p < 0.001) and LVEF (HR 0.98, p = 0.020) were independent predictors of mortality. Men aged >60 years with a non-ischaemic aetiology on their CMR were at higher risk of death than women with non-ischaemic causes >60 years (p = 0.003, figure 2). Conclusions There is no difference in all-cause mortality between sexes in MINOCA but increasing age is the most important predictor of mortality in both sexes.

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