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Myocardial Infarction with Non-Obstructive Coronary Arteries: The Importance of Achieving Secondary Prevention Targets
Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Cardiology, Falun Hospital, Falun, Sweden.
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2018 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 131, no 5, p. 524-531Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Around 5-10% of all myocardial infarction patients have non-obstructive coronary arteries. Studies investigating the importance of follow-up and achievement of conventional secondary prevention targets in these patients are lacking.

METHODS: In this analysis from the SWEDEHEART registry, we investigated 5830 myocardial infarction patients with non-obstructive coronary arteries (group 1) and 54,637 myocardial infarction patients with significant coronary artery disease (≥50% stenosis; group 2). Multivariable- and propensity score-adjusted statistics were used to assess the reduction in the one-year risk of major adverse events associated with prespecified secondary preventive measures: participation in follow-up at 6-10 weeks after the hospitalization; achievement of secondary prevention targets (blood pressure and low-density lipoprotein cholesterol levels in the target ranges, non-smoking, participation in exercise training).

RESULTS: Patients in group 1 were less often followed up compared to patients in group 2 and less often achieved any of the secondary prevention targets. Participation in the 6-10 week follow-up was associated with a 3-20% risk reduction in group 1, similar as for group 2 according to interaction analysis. The improvement in outcome in group 1 was mainly mediated by achieving target range low-density lipoprotein cholesterol levels (24-32% risk reduction) and, to a smaller extent, by participation in exercise training (10-23% risk reduction).

CONCLUSIONS: Selected secondary preventive measures are associated with prognostic benefit in myocardial infarction patients with non-obstructive coronary arteries, in particular achieving target range low-density lipoprotein cholesterol levels. Our results indicate that these patients should receive similar follow-up as myocardial infarction patients with significant coronary stenoses.

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 131, no 5, p. 524-531
Keywords [en]
Follow-up, Myocardial infarction, Myocardial infarction with non-obstructive coronary arteries, Prognosis, Secondary prevention
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-64006DOI: 10.1016/j.amjmed.2017.12.008ISI: 000430269500039PubMedID: 29287973Scopus ID: 2-s2.0-85041622698OAI: oai:DiVA.org:oru-64006DiVA, id: diva2:1173191
Funder
Swedish Foundation for Strategic Research Available from: 2018-01-11 Created: 2018-01-11 Last updated: 2018-05-02Bibliographically approved

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Nordenskjöld, Anna M.

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