Myocardial infarction with non-obstructive coronary arteries as compared withmyocardial infarction and obstructive coronary disease: Outcomes in aMedicare population

Rachel P. Dreyer, Rosanna Tavella, Jeptha P. Curtis, Yongfei Wang, Sivabaskari Pauspathy, John Messenger, John S. Rumsfeld, Thomas M. Maddox, Harlan M. Krumholz, John A. Spertus, John F. Beltrame

Research output: Contribution to journalArticlepeer-review

74 Scopus citations

Abstract

Aims The prognosis of patients with MINOCA (myocardial infarction with non-obstructive coronary arteries) is poorly understood. We examined major adverse cardiac events (MACE) defined as all-cause mortality, re-hospitalization for acute myocardial infarction (AMI), heart failure (HF), or stroke 12-months post-AMI in patients with MINOCA versus AMI patients with obstructive coronary artery disease (MICAD). Methods and results Multicentre, observational cohort study of patients with AMI (>65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or MINOCA by the presence or absence of an epicardial vessel with >50% stenosis. The primary endpoint was MACE at 12 months, and secondary endpoints included the components of MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had MINOCA. The 12-month rates of MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for MINOCA vs. MICAD patients (P < 0.001), but was similar between MINOCA and MICAD patients for rehospitalization for stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment, MINOCA patients had a 43% lower risk of MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the MACE components. Conclusion This study confirms an unfavourable prognosis in elderly patients with MINOCA undergoing coronary angiography, with one in five patients with MINOCA suffering a major adverse event over 12 months.

Original languageEnglish
Pages (from-to)870-878
Number of pages9
JournalEuropean heart journal
Volume41
Issue number7
DOIs
StatePublished - Feb 14 2020

Keywords

  • AMI and obstructive coronary disease
  • Clinical outcomes
  • Myocardial infarction with non-obstructive coronary arteries
  • Prognosis

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