ST-segment elevation myocardial infarction with non-obstructive coronary arteries: Score derivation for prediction
Magdalena Jędrychowska1, Zbigniew Siudak2, Krzysztof Piotr Malinowski3
12nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Kraków, Poland.
Insights
A new score helps identify patients with ST-segment elevation myocardial infarction (STEMI) and non-obstructive coronary arteries (MINOCA), differentiating them from those with obstructive coronary artery disease (MI-CAD). This tool aids in predicting MINOCA likelihood in STEMI patients.
Area of Science:
- Cardiology
- Clinical Research
- Predictive Modeling
Background:
- ST-segment elevation myocardial infarction (STEMI) patients with obstructive coronary arteries (MI-CAD) typically undergo primary percutaneous coronary intervention (pPCI).
- STEMI patients with non-obstructive coronary arteries (MINOCA) usually receive non-invasive therapy.
- Distinguishing MINOCA from MI-CAD in STEMI is crucial for appropriate treatment stratification.
Purpose of the Study:
- To develop and validate a predictive score for identifying patients with suspected MINOCA within the broader STEMI population.
- To create a tool that assists clinicians in differentiating MINOCA from MI-CAD in STEMI cases.
Main Methods:
- Analysis of a large national registry of percutaneous coronary interventions (PCIs) in Poland (2014-2019).
- Selection of STEMI patients treated with pPCI and those diagnosed with MINOCA.
- Development of a regression model to create a predictive score and a nomogram for MINOCA suspicion.
Main Results:
- Patients with MINOCA were younger, less frequently male, and had fewer comorbidities compared to MI-CAD patients.
- The developed score demonstrated varying probabilities of MINOCA: <0.2% for scores <500, 19% for scores >600, and 71% for scores >650.
- The score effectively differentiates MINOCA from MI-CAD within the STEMI cohort.
Conclusions:
- A novel scoring system can reliably predict the likelihood of MINOCA in patients presenting with STEMI.
- This score facilitates the distinction between MINOCA and MI-CAD, guiding clinical management decisions.
- The developed nomogram serves as a practical tool for assessing MINOCA probability in STEMI patients.
Background:
Acute myocardial infarction with ST-segment elevation (STEMI) and obstructive coronary arteries (MI-CAD) are treated with primary percutaneous coronary interventions (pPCI), while patients with STEMI and non-obstructive coronary arteries (MINOCA), usually require non-invasive therapy. The aim of the study is to design a score for predicting suspected MINOCA among an overall group of STEMI patients.
Materials And Methods:
Based on the Polish national registry of PCIs, we evaluated patients between 2014 and 2019, and selected 526,490 subjects treated with PCI and 650,728 treated using only coronary angiography. These subjects were chosen out of 1,177,218 patients who underwent coronary angiography. Then, we selected 124,663 individuals treated with pPCI due to STEMI and 5,695 patients with STEMI and MINOCA. The score for suspected MINOCA was created using the regression model, while the coefficients calculated for the final model were used to construct a predictive model in the form of a nomogram.
Results:
Patients with MINOCA differ significantly from those in the MI-CAD group; they were significantly younger, less often males and demonstrated smaller burden of concomitant diseases. The model allowed to show that patients who scored more than 600 points had a 19% probability of MINOCA, while for those scoring more than 650 points, the likelihood was 71%. The other end of the MINOCA probability scale was marginal for patients who scored less than 500 points (< .2%).
Conclusions:
Based on the created MINOCA score presented in the current publication, we are able to distinguish MINOCA from MI-CAD patients in the STEMI group.
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