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Clinical Characteristics and Prognosis of MINOCA Caused by Atherosclerotic and Nonatherosclerotic Mechanisms Assessed by OCT.
Zeng, Ming; Zhao, Chen; Bao, Xiaoyi; Liu, Minghao; He, Luping; Xu, Yishuo; Meng, Wei; Qin, Yuhan; Weng, Ziqian; Yi, Boling; Zhang, Dirui; Wang, Shengfang; Luo, Xing; Lv, Ying; Chen, Xi; Sun, Qianhui; Feng, Xue; Gao, Zhanqun; Sun, Yanli; Demuyakor, Abigail; Li, Ji; Hu, Sining; Guagliumi, Giulio; Mintz, Gary S; Jia, Haibo; Yu, Bo.
Afiliação
  • Zeng M; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Zhao C; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Bao X; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Liu M; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • He L; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Xu Y; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Meng W; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Qin Y; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Weng Z; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Yi B; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Zhang D; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Wang S; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Luo X; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Lv Y; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Chen X; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Sun Q; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Feng X; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Gao Z; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Sun Y; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Demuyakor A; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Li J; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Hu S; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China.
  • Guagliumi G; Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
  • Mintz GS; Cardiovascular Research Foundation, New York, New York, USA.
  • Jia H; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: jhb101180@163.com.
  • Yu B; Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China; The Key Laboratory of Medical Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.
JACC Cardiovasc Imaging ; 16(4): 521-532, 2023 04.
Article em En | MEDLINE | ID: mdl-36648054
ABSTRACT

BACKGROUND:

Myocardial infarction with nonobstructive coronary artery (MINOCA) is a heterogeneous syndrome caused by different pathophysiologic mechanisms. There is limited evidence regarding prognosis of patients with MINOCA caused by different mechanisms.

OBJECTIVES:

The present study aimed to assess the underlying mechanisms of MINOCA by optical coherence tomography (OCT) and to correlate with clinical outcomes.

METHODS:

Patients with MINOCA were divided into 2 groups based on OCT

findings:

atherosclerotic MINOCA (Ath-MINOCA) and nonatherosclerotic MINOCA (non-Ath-MINOCA). Major adverse cardiac events (MACE) were defined as cardiac death, nonfatal MI, target lesion revascularization, stroke, and rehospitalization for unstable or progressive angina.

RESULTS:

Among 7,423 patients with a clinical diagnosis of MI who underwent angiography, 190 of 294 MINOCA were studied using OCT. The causes of Ath-MINOCA (n = 99, 52.1%) were plaque erosion (n = 64, 33.7%), plaque rupture (n = 33, 17.4%), and calcified nodule (n = 2, 1.1%) whereas the causes of non-Ath-MINOCA (n = 91, 47.9%) were spontaneous coronary artery dissection (n = 8, 4.2%), coronary spasm (n = 9, 4.7%), and unclassified cause (n = 74, 38.9%). The 1-year MACE was 15.3% for Ath-MINOCA vs 4.5% for non-Ath-MINOCA (P = 0.015). An atherosclerotic cause was an independent predictor of MACE (HR 5.36 [95% CI 1.08-26.55]; P = 0.040), mainly driven by target lesion revascularization and rehospitalization, despite the composite endpoint including cardiac death and MI showing no difference.

CONCLUSIONS:

OCT identified a cause in 61.1% of MINOCA, in which Ath-MINOCA represents an important and distinct MINOCA subset. Ath-MINOCA were more common and associated with worse outcomes. (Incidence Rate of Heart Failure After Acute Myocardial Infarction With Optimal Treatment; NCT03297164; Paradigm Shift in the Treatment of Patients With ACS; NCT02041650).
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: JACC Cardiovasc Imaging Assunto da revista: ANGIOLOGIA / CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Ano de publicação: 2023 Tipo de documento: Article País de afiliação: China
Texto completo
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XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Infarto do Miocárdio Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: JACC Cardiovasc Imaging Assunto da revista: ANGIOLOGIA / CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Ano de publicação: 2023 Tipo de documento: Article País de afiliação: China