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Prevalence of Myocardial Infarction With Obstructive and Non-Obstructive Coronary Arteries in a Middle-Aged
Josefin Sundh1, Magnus Ekström2, Anders Blomberg3
1Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Insights
Middle-aged individuals with chronic airway limitation (CAL) face a doubled risk of myocardial infarction with obstructive coronary artery disease (MI-CAD) and myocardial infarction with non-obstructive coronary arteries (MINOCA). Risk profiles differ by sex, highlighting the need to consider both MI types in CAL patients.
Area of Science:
- Cardiology
- Pulmonology
- Epidemiology
Background:
- Myocardial infarctions (MIs) are categorized into MI with obstructive coronary artery disease (MI-CAD) and MI with non-obstructive coronary arteries (MINOCA).
- Chronic airway limitation (CAL) is a common condition, particularly in middle-aged populations, with potential cardiovascular implications.
Purpose of the Study:
- To determine the prevalence of MI-CAD and MINOCA in individuals with CAL.
- To evaluate whether CAL is an independent risk factor for both MI-CAD and MINOCA.
- To explore these associations stratified by sex and smoking history.
Main Methods:
- Cross-sectional analysis of the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort (n=20,882, aged 50-64).
- CAL defined by post-bronchodilator FEV1/FVC ratio < 0.70.
- MI-CAD and MINOCA defined based on self-reported MI history and coronary computed tomography angiography findings.
Main Results:
- CAL was present in 8.3% of participants (n=1735).
- Individuals with CAL had a nearly doubled independent risk for MI-CAD (aOR 1.72) and MINOCA (aOR 1.99) compared to those without CAL.
- Sex-specific differences observed: CAL increased MINOCA risk in men (aOR 2.63) and MI-CAD risk in women (aOR 3.43).
Conclusions:
- Middle-aged individuals with CAL exhibit a significantly elevated risk for both MI-CAD and MINOCA.
- The study identified distinct sex-based risk patterns for MI types in the context of CAL.
- Clinical consideration of both MI-CAD and MINOCA is warranted in patients diagnosed with CAL.
Purpose:
Myocardial infarctions (MIs) can occur in underlying obstructive coronary artery disease (MI-CAD) or in non-obstructive coronary arteries (MINOCA). The primary objectives of the study were to investigate the prevalence of MI-CAD and MINOCA in people with CAL, and to explore if CAL is an independent risk factor for MI-CAD and MINOCA. Secondary objectives were to explore these research questions stratified by sex and by smoking history.
Patients And Methods:
Cross-sectional analysis of the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) of people aged 50-64 years. CAL was defined as a post-bronchodilator ratio of forced expiratory volume in one second and forced vital capacity below 0.70. MI-CAD was defined as a self-reported MI with coronary computed tomography angiography findings of previous revascularization or at least one significant coronary stenosis (>50%), and MINOCA as self-reported MI with no previous revascularization and no significant coronary stenosis.
Results:
In total, 1735 (8.3%) of 20,882 included participants had CAL. MI-CAD was more common than MINOCA both in people with (2.8 vs 0.6%) and without CAL (1.2 vs 0.3%). Compared with those without CAL, people with CAL had an almost doubled independent risk of both MI-CAD ([adjusted OR] 1.72; [95% CI] 1.22-2.42) and MINOCA (1.99; 1.02-3.86). In men, CAL was associated with increased risk of MINOCA (2.63; 1.23-5.64), and in women with increased risk for MI-CAD (3.43; 1.68-1.26).
Conclusion:
Middle-aged people with CAL have an almost doubled risk of both MI-CAD and MINOCA, compared with people without CAL. In contrast to people without CAL, the risk of MINOCA is increased in men and the risk of MI-CAD is increased in women. In a clinical context, both MI types should be considered in CAL.
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