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- Title
Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers.
- Authors
Quesada, Odayme; Yildiz, Mehmet; Henry, Timothy D.; Bergstedt, Seth; Chambers, Jenny; Shah, Ananya; Stanberry, Larissa; Volpenhein, Lucas; Aziz, Dalia; Lantz, Rebekah; Palmer, Cassady; Ugwu, Justin; Ahsan, Muhammad J.; Garberich, Ross F.; Rohm, Heather S.; Aguirre, Frank V.; Garcia, Santiago; Sharkey, Scott W.
- Abstract
This cohort study evaluates mortality in ST-segment elevation myocardial infarction with nonobstructive coronary arteries. Key Points: Question: Is 5-year mortality different in patients with ST-segment elevation myocardial infarction (STEMI) presenting with nonobstructive coronaries (MINOCA) and MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy) as compared with patients with obstructive disease? Findings: In this cohort study of 8560 consecutive patients with STEMI, compared with obstructive disease, 5-year mortality hazard risk was higher in patients with MINOCA and similar in patients with MINOCA mimickers. Meaning: The findings of this study suggest that STEMI without obstructive disease is a morbid disease, emphasizing the need to diagnose the underlying cause of MINOCA and MINOCA mimickers at the time of the event. Importance: The clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown. Objective: To assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimickers as compared with obstructive disease. Design, Setting, and Participants: A retrospective analysis of a prospective registry-based cohort study of consecutive STEMI activations at 3 regional Midwest STEMI programs. STEMI without a culprit artery and elevated troponin levels were categorized as MINOCA (absence of coronary artery stenosis >50% and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) or MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy). Data were analyzed from March 2003 to December 2020. Main Outcomes and Measures: Adjusted Cox regression analysis was used to assess 5-year mortality risk in STEMI presenting with MINOCA and MINOCA mimickers in comparison with obstructive disease. Results: Among 8560 consecutive patients with STEMI, mean (SD) age was 62 (14) years, 30% were female (2609 participants), and 94% were non-Hispanic White (4358 participants). The cohort included 8151 patients with STEMI due to obstructive disease (95.2%), 120 patients with MINOCA (1.4%), and 289 patients with MINOCA mimickers (3.8%). Patients were followed up for a median (IQR) of 7.1 (3.6-10.7) years. Patients with MINOCA and MINOCA mimickers were less likely to be discharged with cardiac medications compared with obstructive disease. At 5-year follow-up, mortality in STEMI presenting with obstructive disease (1228 participants [16%]) was similar to MINOCA (20 participants [18%]; χ21 = 1.1; log-rank P =.29) and MINOCA mimickers (52 participants [18%]; χ21 = 2.3; log-rank P =.13). In adjusted Cox regression analysis compared with obstructive disease, the 5-year mortality hazard risk was 1.93 times higher in MINOCA (95% CI, 1.06-3.53) and similar in MINOCA mimickers (HR, 1.08; 95% CI, 0.79-1.49). Conclusions and Relevance: In this large multicenter cohort study of consecutive clinical patients with STEMI, presenting with MINOCA was associated with a higher risk of mortality than obstructive disease; the risk of mortality was similar in patients with MINOCA mimickers and obstructive disease. Further investigation is necessary to understand the pathophysiologic mechanisms involved in this high-risk STEMI population.
- Subjects
STATISTICS; RESEARCH; CONFIDENCE intervals; MAJOR adverse cardiovascular events; MULTIVARIATE analysis; RETROSPECTIVE studies; MYOCARDIAL infarction; MANN Whitney U Test; FISHER exact test; ST elevation myocardial infarction; T-test (Statistics); CORONARY artery disease; RESEARCH funding; CHI-squared test; KAPLAN-Meier estimator; DATA analysis; DATA analysis software; LONGITUDINAL method; PROPORTIONAL hazards models; SECONDARY analysis
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2343402
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.43402