부산대학교 도서관

BACKGROUND:: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an underrecognized clinical problem in patients presenting with acute coronary syndrome. Various clinical disorders lead to MINOCA thus making treatment and diagnosis a challenge. We aimed to compare the clinical factors and outcomes of patients with MINOCA versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) in a largely rural health system. METHODS:: Between 5/01/2009 -6/24/2019, all consecutive ST-segment elevation myocardial infarction patients at Essentia Health were prospectively examined. We categorized patients into MI-CAD (obstructive plaque ≥50% with revascularization) or MINOCA (obstructive plaque <50% with exclusion of other alternative cause). Outcomes included 30-day and 1-year all-cause mortality, 30-day all-cause readmission and 30-day cardiac readmission. RESULTS:: There were 2,170 patients included in the study; 2097 (96.6 %) had MI-CAD and 73 (3.4%) met the definition of MINOCA. Within the MINOCA group, the three most common presentations were: supply-demand mismatch (28.8%), spontaneous coronary artery dissection (9.6%), and other etiology (60.3%). Only 10 (13 %) MINOCA patients had cardiac magnetic resonance imaging studies obtained within 6 months. MINOCA patients were younger 61.6 years vs 63.4 years with higher left ventricular function 51.6% vs 50.4% with less likelihood of prior myocardial infarction 4.1 % vs. 15.5% or congestive heart failure 2.7% vs. 6.3%; (p<0.05). Compared to MI-CAD patients, MINOCA patients had similar 30-day mortality (7.1% vs. 8.2%; p=0.70), 1-year mortality (10.4% vs. 8.2 %; p=0.55) and 30-day cardiac readmission (8.7 % vs. 9.6%; p=0.29). MINOCA patients were less likely to be discharged on aspirin, betablockers, ACEi/ARB or statins (p<0.05). CONCLUSION:: Though there was no difference in readmission and mortality between MINOCA and MI-CAD; use of secondary-prevention medications and cardiac rehabilitation referral was low in MINOCA patients. Prospective studies will be relevant to assess effective medical therapy to improve outcomes in MINOCA patients.