Myocardial infarction with nonobstructive coronary arteries - the European PERspective (SNIPER) survey
Doralisa Morrone1, Giulio Stefanini2, Marco De Carlo1
1Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa.
Insights
Diagnosis and management of myocardial infarction with nonobstructive coronary arteries (MINOCA) vary significantly across European centers. A unified approach and guideline adherence are needed for better patient outcomes in MINOCA cases.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Practice
Background:
- Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents a diagnostic challenge due to its heterogeneous nature.
- Current practices for MINOCA diagnosis and management require evaluation to identify gaps and improve patient care.
Purpose of the Study:
- To assess current diagnostic and management strategies for MINOCA in European academic centers.
- To identify variations and gaps in clinical practice concerning MINOCA.
Main Methods:
- An electronic survey was distributed to 42 European academic centers between June and October 2023.
- Data on MINOCA demographics, perceived clinical impact, testing, and treatments were collected from 41 participating centers.
Main Results:
- MINOCA constitutes about 10% of myocardial infarction cases, with varied perceptions of its prognostic risk.
- Significant heterogeneity exists in diagnostic algorithms, with only 22% of centers employing comprehensive approaches. Intravascular imaging and cardiac MRI are commonly used.
- A majority of centers considered empiric therapy acceptable without functional testing, indicating diagnostic inertia.
Conclusions:
- A significant lack of uniformity in MINOCA diagnostic approaches and adherence to guidelines was observed across European academic centers.
- There is a critical need for a standardized diagnostic strategy and closer alignment with established guidelines for MINOCA management.
Background And Aims:
Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a heterogeneous group of clinical entities requiring further investigation to assess prognosis and guide treatment. We evaluated current diagnostic practices across European academic centres in its diagnosis and management, to focus on current gaps in clinical practice.
Methods:
Between June and October 2023, we distributed an electronic survey to 42 centres selected from a 2023 list of European Association of Percutaneous Cardiovascular Interventions Hosting Academic Centres, obtaining information on demographics of MINOCA, perceived clinical impact, testing and treatments.
Results:
The analysis was based on data from 41 centres. According to the survey, MINOCA accounts for approximately 10% of MI cases. Only 38% of the respondents perceived MINOCA as increasing the risk for future major adverse cardiovascular events. Sixty-three percent of centres agreed on the need for further testing after MINOCA diagnosis, and 22% reported proceeding with a comprehensive diagnostic algorithm. Intravascular (51%) and cardiac magnetic resonance imaging (50%) were the most common diagnostic tools used. Coronary plaque disruption was perceived as the most frequent cause based on respondents' opinions. Sixty-nine percent of centres considered 'empiric' therapy acceptable without functional testing.
Conclusions:
This survey revealed a significant heterogeneity in the diagnostic approaches to MINOCA in academic European centres, with variable belief of its clinical impact, wide variation in diagnostic algorithms, noteworthy diagnostic inertia, and poor adherence to guideline recommendations. All these point to a pressing need for a unified approach to MINOCA testing and a much closer alignment to guidelines.
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