Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
Odayme Quesada1,2, Mehmet Yildiz2, Timothy D Henry2
1Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio.
JAMA Network Open
|November 16, 2023
Summary
Patients with ST-segment elevation myocardial infarction (STEMI) and myocardial infarction with nonobstructive coronary arteries (MINOCA) face a higher mortality risk. This study found MINOCA associated with increased mortality compared to obstructive coronary artery disease, while MINOCA mimickers showed similar risks.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- The prognosis for patients experiencing ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronary arteries (MINOCA) remains poorly understood.
- Understanding the differences in outcomes between MINOCA, MINOCA mimickers, and obstructive coronary artery disease is crucial for patient management.
Purpose of the Study:
- To compare the 5-year mortality rates among patients presenting with STEMI due to MINOCA, MINOCA mimickers, and obstructive coronary artery disease.
- To identify potential differences in clinical characteristics and prognosis within these STEMI subgroups.
Main Methods:
- A retrospective analysis of a prospective registry-based cohort study involving consecutive STEMI activations across three Midwest STEMI programs.
- Patients were categorized into MINOCA, MINOCA mimickers (e.g., takotsubo cardiomyopathy, myocarditis), or obstructive disease based on coronary angiography and troponin levels.
- Adjusted Cox regression analysis was employed to assess 5-year mortality risk.
Main Results:
- The study included 8560 STEMI patients: 95.2% obstructive disease, 1.4% MINOCA, and 3.8% MINOCA mimickers.
- At 5-year follow-up, mortality rates were 16% for obstructive disease, 18% for MINOCA, and 18% for MINOCA mimickers.
- Adjusted analysis revealed a 1.93-fold higher 5-year mortality hazard risk for MINOCA compared to obstructive disease, with no significant difference for MINOCA mimickers.
Conclusions:
- STEMI patients presenting with MINOCA have a significantly higher risk of mortality compared to those with obstructive coronary artery disease.
- The mortality risk for MINOCA mimickers was similar to that of obstructive coronary artery disease.
- Further research is warranted to elucidate the underlying pathophysiologic mechanisms in the high-risk MINOCA population.
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