2024-03-28T23:36:20Zhttp://repisalud.isciii.es/oai/requestoai:repisalud.isciii.es:20.500.12105/72262023-10-05T07:17:17Zcom_20.500.12105_2145com_20.500.12105_2051com_20.500.12105_2144col_20.500.12105_2146
00925njm 22002777a 4500
dc
Safdar, Basmah
author
Spatz, Erica S
author
Dreyer, Rachel P
author
Beltrame, John F
author
Lichtman, Judith H
author
Spertus, John A
author
Reynolds, Harmony R
author
Geda, Mary
author
Bueno, Hector
author
Dziura, James D
author
Krumholz, Harlan M
author
D'Onofrio, Gail
author
2018-06-28
BACKGROUND: We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) and among patients with MINOCA by sex and subtype. METHODS AND RESULTS: Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI-CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1- and 12-month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI-CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29-7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI-CAD patients (3.0% versus 1.3%; P=0.036). Women with MI-CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One- and 12-month mortality with MINOCA and MI-CAD was similar (1-month: 1.1% and 1.7% [P=0.43]; 12-month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12-month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06). CONCLUSIONS: Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI-CAD patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.
J Am Heart Assoc. 2018; 7(13):e009174
2047-9980
http://hdl.handle.net/20.500.12105/7226
29954744
10.1161/JAHA.118.009174
2047-9980
Journal of the American Heart Association
Acute myocardial infarction
Myocardial infarction with nonobstructive coronary arteries
Nonobstructive
Prognosis
Sex
Women
Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study