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Reinfarction in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA): coronary findings and prognosis
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiology.
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 Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
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2019 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 132, no 3, p. 335-346Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.

METHODS: In this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013 we identified 9,092 unique patients with MINOCA out of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.

RESULTS: The mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had one-vessel, 26 had two-vessel, 9 had three-vessel disease and two had left main together with one-vessel disease. Male gender, diabetes, peripheral vascular disease, higher levels of creatinine and ST-elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs. 11.9% (p=0.54).

CONCLUSIONS: About half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD.

Place, publisher, year, edition, pages
Elsevier, 2019. Vol. 132, no 3, p. 335-346
Keywords [en]
Coronary angiography, Coronary artery disease, Predictors, SWEDEHEART
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-69887DOI: 10.1016/j.amjmed.2018.10.007ISI: 000459911500030PubMedID: 30367850Scopus ID: 2-s2.0-85059443715OAI: oai:DiVA.org:oru-69887DiVA, id: diva2:1261158
Funder
Swedish Foundation for Strategic Research Swedish Society of Cardiology
Note

Funding Agencies:

Swedish Society of Thoracic Radiology  

Swedish Society of Thoracic Surgery  

Swedish Heart Association  

Swedish Association of Local Authorities and Regions 

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-06-19Bibliographically approved

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Nordenskjöld, Anna M.

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CiteExportLink to record
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