Characteristics and Long-term Mortality in Patients with ST-Segment Elevation Myocardial Infarction with
Insights
ST-segment elevation myocardial infarction with non-obstructive coronaries (STE-MINOCA) affects nearly 5% of STEMI patients. STE-MINOCA patients face a 40% higher risk of 5-year mortality compared to those with coronary obstruction.
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.
Background:
The prognosis of ST-segment elevation myocardial infarction with non-obstructive coronaries (STE-MINOCA) is largely unknown.
Methods:
The objective of this study is to evaluate the prevalence, characteristics, and 5-year mortality of patients with STE-MINOCA compared to STEMI with coronary artery obstruction (STEMI-Obstruction) using a multicenter cohort of consecutive STEMI patients at 3 regional Midwest STEMI programs from 2003 to 2020. STE-MINOCA was defined based on (1) coronary stenosis < 60% by visual estimation, (2) ischemia with elevated troponin, and (3) no alternative diagnosis. STE-MINOCA was further classified based on American Heart Association (AHA) definition as AHA STE-MINOCA and AHA STE-MINOCA Mimicker.
Results:
8,566 STEMI patients, including 420 (4.9%) STE-MINOCA (26.9% AHA STE-MINOCA and 73.1% AHA STE-MINOCA Mimicker) were followed for a median of 7.1 years. Compared to STEMI-Obstruction, STE-MINOCA were younger, more often female, had fewer cardiovascular risk factors, and were less likely to be discharged on cardiac medications. At five years, mortality was higher in STE-MINOCA compared with STEMI-Obstruction (18% vs. 15%, p=0.033). In propensity score-matched analysis, STE-MINOCA had a 1.4-fold (95% CI: 1.04-1.89, p=0.028) higher risk of 5-year all-cause mortality compared with STEMI-Obstruction. Furthermore, 5-year mortality risk was significantly higher in AHA STE-MINOCA Mimicker (19% vs. 15%, p=0.043) but similar in AHA STE-MINOCA (17% vs. 15%, p=0.42) compared with STEMI-Obstruction.
Conclusions:
In this large multicenter STEMI cohort, nearly 5% of patients presented with STE-MINOCA. At five years, mortality approached 20% among patients with STE-MINOCA. Despite the lower risk profile, STE-MINOCA patients were at 40% higher risk of 5-year all-cause mortality compared with STEMI-Obstruction. Additionally, 5-year all-cause mortality risk was higher in AHA STE-MINOCA Mimicker but similar in AHA STE-MINOCA compared to STEMI-Obstruction.
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