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MINOCA presenting with STEMI: incidence, aetiology and outcome in a contemporaneous cohort
Ying X Gue1,2,3, Natasha Corballis4, Alisdair Ryding4,5
1University of Hertfordshire, Hertfordshire, UK. y.gue@nhs.net.
Insights
Approximately 4.4% of ST-segment elevation myocardial infarction (STEMI) patients were diagnosed with myocardial infarction with no obstructive coronary artery disease (MINOCA) using current criteria. This study highlights a significant incidence of MINOCA in STEMI cohorts, with notable mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Historical data suggest ~10% of acute coronary syndrome patients lack obstructive coronary artery disease (CAD).
- Contemporary incidence of myocardial infarction (MI) without obstructive CAD in ST-segment elevation myocardial infarction (STEMI) is not well-defined.
- Myocardial infarction with no obstructive coronary artery disease (MINOCA) diagnosis requires adherence to specific European Society of Cardiology (ESC) criteria.
Purpose of the Study:
- To determine the contemporary incidence of MINOCA in STEMI patients based on ESC criteria.
- To evaluate the clinical outcomes, including 30-day and 1-year mortality, for STEMI patients with MINOCA.
- To provide data for future clinical trials investigating MINOCA.
Main Methods:
- Consecutive, unselected STEMI patients undergoing primary percutaneous coronary intervention (PPCI) were assessed.
- MINOCA diagnosis was established using ESC criteria.
- Data from electronic patient records, blood tests, and angiographic/echocardiographic imaging were analyzed to determine final diagnoses and mortality rates.
Main Results:
- Out of 2521 STEMI patients, 110 (4.4%) met the diagnostic criteria for MINOCA.
- The majority of STEMI patients (85.6%) had obstructive CAD requiring PPCI.
- All-cause mortality at 30 days was 3.6%, and at 1 year was 4.5% in the MINOCA cohort.
Conclusions:
- This study reports a significant contemporary incidence of MINOCA (4.4%) in a STEMI population using current ESC definitions.
- The observed mortality rates in STEMI patients with MINOCA were substantial and comparable to findings in large meta-analyses.
- The findings underscore the clinical relevance of MINOCA in STEMI and provide crucial data for future research and clinical trial design.
Abstract:
Historical data indicate that approximately 10% of acute coronary syndrome patients have no obstructive coronary artery disease (CAD) but contemporary incidence of non-obstructed coronary arteries in ST-segment elevation myocardial infarction (STEMI) is not clear. We aimed both to identify the contemporary incidence of MI without obstructive CAD (MINOCA)-using the ESC definition-and assess clinical outcomes. We assessed consecutive unselected STEMI patients presenting to the cardiac catheterisation laboratory with a view to undergoing primary percutaneous coronary intervention (PPCI). MINOCA was defined according to ESC criteria. Electronic patient records, blood results, angiographic and echocardiographic data were interrogated to determine final diagnosis, as well as 30-day and 1-year mortality rate. Of 2521 patients with full electronic dataset, 2158 (85.6%) underwent PPCI for obstructive CAD (angiographic stenosis > 70%). A further 167 (6.6%) with obstructive CAD were treated medically or surgically. The remaining 196 (7.8%) patients had absence of obstructive CAD at angiography, of whom 167 had no stenosis (< 30%) and 29 had mild coronary atheroma (stenosis > 30% but < 50%). A total of 110 (4.4%) patients met diagnostic criteria for MINOCA. All-cause mortality at 30-days and 1-year were 3.6% and 4.5%, respectively. In our cohort, 1 in 20 patients presenting with STEMI had MINOCA. This is the first description of the relatively high incidence of MINOCA in a STEMI cohort using current ESC definition and diagnostic criteria and could help power future trials in this area. Mortality rate was relatively high in our study and similar to that in large meta-analyses.
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