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Myocardial Infarction with Nonobstructive Coronary Arteries: The Importance of Achieving Secondary Prevention Targets
Kai M Eggers1, Nermin Hadziosmanovic1, Tomasz Baron1
1Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Insights
Patients with myocardial infarction and nonobstructive coronary arteries benefit from secondary prevention strategies. Achieving target low-density lipoprotein cholesterol levels significantly reduces adverse events, similar to patients with significant coronary artery disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Public Health
Background:
- Myocardial infarction (MI) with nonobstructive coronary arteries (INOCA) affects 5-10% of patients.
- Limited research exists on the importance of secondary prevention in INOCA patients.
Purpose of the Study:
- To investigate the prognostic impact of follow-up and secondary preventive measures in INOCA patients.
- To compare outcomes between INOCA patients and those with significant coronary artery disease.
Main Methods:
- Analysis of the SWEDEHEART registry data.
- Inclusion of 5830 INOCA patients (Group 1) and 54,637 patients with significant coronary artery disease (Group 2).
- Multivariable and propensity score-adjusted analyses assessed the 1-year risk of major adverse events related to follow-up and secondary prevention targets.
Main Results:
- INOCA patients had less frequent follow-up and lower achievement of secondary prevention targets.
- 6-10 week follow-up reduced risk by 3-20% in INOCA patients, comparable to Group 2.
- Low-density lipoprotein cholesterol target achievement (24-32% risk reduction) and exercise training (10-23% risk reduction) were key mediators of improved outcomes in INOCA patients.
Conclusions:
- Secondary preventive measures, especially achieving target LDL-C, offer prognostic benefits for INOCA patients.
- INOCA patients warrant similar follow-up intensity as those with obstructive coronary artery disease.
Background:
Approximately 5% to 10% of all patients with myocardial infarction have nonobstructive 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 Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry, we investigated 5830 patients with myocardial infarction with nonobstructive coronary arteries (group 1) and 54,637 patients with myocardial infarction with significant coronary artery disease (≥50% stenosis; group 2). Multivariable- and propensity score-adjusted statistics were used to assess the reduction in the 1-year risk of major adverse events associated with prespecified secondary preventive measures: participation in follow-up at 6 to 10 weeks after the hospitalization and achievement of secondary prevention targets (blood pressure and low-density lipoprotein cholesterol levels in the target ranges, nonsmoking, and participation in exercise training).
Results:
Patients in group 1 were less often followed up compared with patients in group 2 and less often achieved any of the secondary prevention targets. Participation in the 6- to 10-week follow-up was associated with a 3% to 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 patients with myocardial infarction with nonobstructive 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.
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