Raparelli V, et al. - The intent of the authors was to discern the presentation and prognosis of myocardial infarction (MI) with non-obstructive coronary artery disease (MINOCA), on the basis of the severity of coronary artery disease (CAD). Regardless of the absence of obstructive CAD, high-risk features were noted among patients with MINOCA. In order to improve prognosis in young women with premature MI, determination of etiology and eventual treatment was found to be useful.

Methods

• The eligible candidates included patients with premature (<55 years of age) acute MI.
• Data was obtained from 24 centers across Canada.
• A comparative examination was pursued between patients with MINOCA (<50% stenosis) and patients with obstructive CAD (≥50% stenosis) (MICAD), in terms of baseline clinical, psychosocial, and coronary anatomy characteristics as well as 12-month outcomes.

Results

• Out of 1,210 patients with ACS, 998 MI patients with available angiography core lab readings were analyzed.
• A total of 82 patients (8.2%) presented with a MINOCA and 916 (91.8%) had a MICAD.
• As per the findings, 40% of patients with MINOCA were disclosed to be women compared to one-third with MICAD.
• Data illustrated lower prevalence of traditional risk factors and chest pain at presentation in MINOCA patients.
• However, 37% patients reported a STEMI and 10% presented with a cardiac arrest.
• Researchers did not discover any evident etiology in over 70% of MINOCA.
• Either spontaneous coronary dissection or Takotsubo cardiomyopathy was unveiled among 10% patients.
• Despite lower combined MACE and all-cause readmission rate in the MINOCA group (14 vs 25%) (adjusted HR: 0.51 95% CI: .28-.93), it was not revealed to be negligible.