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Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Department of Clinical Sciences, Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
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2018 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 261, p. 18-23Article in journal (Refereed) Published
Abstract [en]

Background: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCAs) is an increasingly recognized entity. No previous study has evaluated predictors for new major adverse cardiacvascular events (MACEs) and death in patients with MINOCA.

Methods: We conducted an observational study of MINOCA patients recorded between July 2003 and June 2013 and followed until December 2013 for outcome events. Out of 199,163 MI admissions, 9092 consecutive unique patients with MINOCA were identified. The mean age was 65.5 years and 62% were women. MACE was defined as all-cause mortality, rehospitalization for acute MI, ischemic stroke and heart failure. Hazard ratio and 95% confidence interval (HR; 95% CI) was calculated using Cox-regression.

Results: A total of 2147 patients (24%) experienced a new MACE and 1254 patients (14%) died during the mean follow-up of 4.5 years. Independent predictors for MACE after adjustment, were older age (1.05; 1.04-1.06), diabetes (1.44; 1.21-1.70), hypertension (1.25; 1.09-1.43), current smoking (1.38; 1.15-1.66), previous myocardial infarction (1.38; 1.04-2.82), previous stroke (1.69; 1.35-2.11), peripheral vascular disease (1.55; 1.97-2.23), chronic obstructive pulmonary disease (1.63; 1.32-2.00), reduced left ventricular ejection fraction (2.00; 1.54-2.60), lower level of total cholesterol (0.88; 0.83-0.94) and higher level of creatinine (1.01; 1.00-1.03). Independent predictors for all cause death were age, current smoking, diabetes, cancer, chronic obstructive pulmonary disease, previous stroke, reduced left ventricular fraction, lower level of total cholesterol and higher levels of creatinine and CRP.

Conclusions: The clinical factors predicting new MACE and death of MINOCA patients seem to be strikingly similar to factors previously shown to predict new cardiovascular events in patients with MI and obstructive coronary artery disease.

Place, publisher, year, edition, pages
Elsevier , 2018. Vol. 261, p. 18-23
Keywords [en]
Myocardial infarction, Myocardial infarction with non-obstructive, coronary arteries, Predictors
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-66831DOI: 10.1016/j.ijcard.2018.03.056ISI: 000430081000004PubMedID: 29563017Scopus ID: 2-s2.0-85043996832OAI: oai:DiVA.org:oru-66831DiVA, id: diva2:1203186
Funder
Swedish Foundation for Strategic Research Available from: 2018-05-02 Created: 2018-05-02 Last updated: 2018-06-19Bibliographically approved

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Nordenskjöld, Anna M.

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