Myocardial infarction with non-obstructive coronary arteries (minoca) in Dokuz Eylül University : Clinical features , prognosis

Introduction and Objectives: Nowadays, coronary artery disease is one of the most common causes of death. Obstructive coronary artery disease caused by atherosclerosis is mainly consist of 90% of myocardial infarction cases. On the other hand, no occlusive coronary lesion was detected in approximately 10% of the cases. It is a heterogeneous diagnostic group that includes patients without severe coronary artery stenosis known as myocardial infarction without obstructive coronary artery disease (MINOCA). While diagnostic treatment algorithms for obstructive coronary artery diseases have been established by evidence-based guidelines, the awareness of clinicians in the MINOCA group has been increasing in recent years. The study aims to determine the demographic and clinical characteristics, underlying aetiology, medical treatment and prognosis outcomes of the patients in the MINOCA group from the MI-CAD group. Material and Methods: A total of 1421 patients with acute myocardial infarction admitted to the hospital between 01.01.2016 and 15.03.2019 were screened for the study retrospectively. Patients with prior history of coronary artery disease and patients with procedure-related acute myocardial infarction were excluded from the study. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. 130 patients with myocardial infarction (MINOCA) without occlusive coronary artery disease and 210 consecutive myocardialinfarction patients with obstructive coronary artery disease (MI-CAD) evaluated as a descriptive group meeting the criteria of the study were included in the study. Data is obtained from the hospital archive, hospital database system and patient via telephone route. Demographic clinical data, ECG imaging features, and characteristics of the drugs prescribed during discharge were determined by a statistical comparison between the groups. The prognosis and cardiovascular complications of MINOCA patients who were followed up for a median of 22.5 (1,9 – 48,5 ) months were also examined. Results: Among all of the 1421 patients with acute myocardial infarction, 130 patients were diagnosed with MINOCA. The prevalence of MINOCA was 10,9%. In terms of demographic characteristics, compared with MI-CAD patients, MINOCA patients were younger (54.65 ± 18.4 - 63.2 ± 12.3 p <0.001), had a higher proportion of females (44.2% - 24.6% p < 0.001) and presented lower proportions of a history of smoking, diabetes, hypertension, hyperlipidaemia. In contrast, patients with MINOCA were more likely to have history of upper-respiratory-tract infections (URIs). It was found that premenopausal women were more common among MINOCA patients in female gender population (24,6 % vs 9,6 %p<0,001). The levels of TK, LDL-C, cTn, CK-MB and WBC in the MINOCA group were significantly lower than other group. Echocardiography revealed that the left ventricular ejection fraction (LVEF) in the MINOCA group was higher (54,9 ± 9,9 - 47,41 ± 9,5 p<0,001). Regional wall motion abnormalities were more common in the MI-CAD group. It was observed that MINOCA patients were taken to catheter laboratory later than MI-CAD patients. Radial intervention was preferred more frequently in MINOCA patients (11,4% vs 3,3% p:0,003). MINOCA patients are less likely to receive secondary prevention medication for MI. At the time of admission, antidepressant drug use was significantly higher in the MINOCA group (29,5% vs 6,3% p<0,001). It was found that the hospital (4,1 ± 3,6 vs 5,1± 4,3 p<0,001) and its coronary intensive care (2,2 ± 1,6 vs 3,2± 1,8 p<0,001) hospitalizations of MINOCA patients were shorter than MI-CAD group. In-hospital mortality was lower in patients with MINOCA than MI-CAD (0% versus 5,7%; P<0.0001). Mortality of MINOCA patients with a median follow-up of 22.5 (1,9 – 48,5 ) months was 7%, and non-mortality adverse events were 9.7%. Conclusion: In light of above, the study shows that MI with non-obstructive coronary disease is common, occurring in approximately one in ten patients. Patients with MINOCA constitute a population that differs from other patients with MI. Compared with MI-CAD, MINOCA was accompanied by fewer traditional risk factors of CAD, less likely to be discharged upon secondary prevention medication of MI. 7% mortality was observed in the median 22.5 (1.9 - 48.5) months follow-up, indicating that MINOCA is not a benign disease. The findings of the study provide the basis for improving the diagnosis and treatment of MINOCA patients in the clinic. Key Words: MINOCA, Treatment, Clinic Features, Nonobstructive Coronary Disease, Prognosis, Nonobstructive