Characteristics and Long-term Mortality in Patients with ST-Segment Elevation Myocardial Infarction with...

Area of Science:

• Cardiology
• Cardiovascular Research
• Clinical Medicine

Background:

• The long-term prognosis for ST-segment elevation myocardial infarction with non-obstructive coronaries (STE-MINOCA) remains largely undefined.
• Understanding the outcomes of STE-MINOCA is crucial for effective patient management and risk stratification.

Approach:

• A multicenter cohort study analyzed 8,566 ST-segment elevation myocardial infarction (STEMI) patients from 2003-2020.
• STE-MINOCA was defined as coronary stenosis <60%, elevated troponin, and no alternative diagnosis, further classified by AHA criteria.
• Propensity score-matched analysis compared 5-year all-cause mortality between STE-MINOCA and STEMI with coronary artery obstruction (STEMI-Obstruction).

Key Points:

• Nearly 5% of STEMI patients (420/8,566) were diagnosed with STE-MINOCA.
• STE-MINOCA patients were younger, more often female, and had fewer cardiovascular risk factors than STEMI-Obstruction.
• Five-year mortality was 18% for STE-MINOCA versus 15% for STEMI-Obstruction (p=0.033).

Conclusions:

• STE-MINOCA patients exhibited a 1.4-fold higher risk of 5-year all-cause mortality compared to STEMI-Obstruction patients, despite a lower initial risk profile.
• The AHA STE-MINOCA Mimicker subgroup showed significantly higher 5-year mortality risk than STEMI-Obstruction.
• Mortality risk was similar between AHA STE-MINOCA and STEMI-Obstruction.