2024-03-29T10:08:03Zhttp://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
Repisalud
author
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
funder
NIH - National Heart, Lung, and Blood Institute (NHLBI) (Estados Unidos)
2019-02-25T09:01:32Z
2019-02-25T09:01:32Z
2018-06-28
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
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.
eng
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
journal article
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URL
https://repisalud.isciii.es/bitstream/20.500.12105/7226/1/PresentationClinicalProfilePrognosis_2018.pdf
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https://repisalud.isciii.es/bitstream/20.500.12105/7226/5/PresentationClinicalProfilePrognosis_2018.pdf.txt
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PresentationClinicalProfilePrognosis_2018.pdf.txt