Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) remains a puzzling clinical entity characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis <50 %). This pathology is poorly understood, several studies are underway for a better understanding of this disease. The aim of our work was to review the literature and assess the epidemiology, clinical features, prognosis and etiologies of MINOCA. Methods and Results: Descriptive, prospective study, spread over a period of 36 months from January 2018 to December 2020 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen, for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (MI-CAD) if there was revascularization or plaque ≥ 50% and as having MINOCA if there was <50% obstruction or a mechanism without plaque. Patients who received thrombolytics before angiography were excluded. We studied the epidemiological, clinical and prognostic profile of the MINOCA population then compared them to patients with obstructive coronary artery disease and finally we established an etiological analysis of the MINOCA population. The number of MINOCA cases in our sample of 585 AMI patients was 10.25% vs. 525 (89.74%) cases of AMI-CO, it was more common in men (78.3% vs. 21, 7%; odds ratio at 3.61) and in the youngest patients. MINOCA patients were more likely to be without traditional cardiac risk factors (7.9% vs. 2.1%; P <0.001) but more predis¬posed to non-traditional risk factors than AMI-CO patients (3.7% against 1.8%; P = 0.026). Smoking is the only traditional risk factor frequent in the MINOCA population versus MI-CAD (P at 0.001). Depression, stress, drug addiction, DVT history and autoimmune disease history are more frequent in the MINOCA population versus MI-CAD (P <0.05). STEMI are more found in the MINOCA population versus MI-CAD (P = 0.000). In terms of prognosis, the MINOCA population had a better prognosis: less risk of recurrence than the MI-CAD population 6.7% versus 10.45% (P = 0.03) also less mortality 0% versus 4.6% (P = 0.007). Conclusions: The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (MI- CAD) however they had a better quality of life and a good prognosis.
| Published in | International Journal of Cardiovascular and Thoracic Surgery (Volume 9, Issue 6) |
| DOI | 10.11648/j.ijcts.20230906.13 |
| Page(s) | 84-91 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2023. Published by Science Publishing Group |
Acute Myocardial Infarction, Myocardial Infarction with Nonobstructive Coronary Arteries, Nonobstructive, Prognosis
| [1] | Niccoli G, Scalone G, Crea F. Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. Eur Heart J 2015; 36(8): 475–481. |
| [2] | Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P, on behalf of the WG on Cardiovascular Pharmacotherapy. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J 2017; 38(3): 143–153. |
| [3] | Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in mortality from ischemic heart disease and cerebrovascular disease in Europe: 1980 to 2009. Circulation 2016; 133(20): 1916–1926. |
| [4] | Townsend N, Wilson L, Bhatnagar P, Wickramasinghe K, Rayner M, Nichols M. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016; 37(42): 3232–3245. |
| [5] | Miller RD, Burchell HB, Edwards JE. Myocardial infarction with and without acute coronary occlusion: a pathologic study. AMA Arch Intern Med. 1951; 88: 597–604. |
| [6] | Gross H, Steinberg WH. Myocardial infarction without significant lesions of coronary arteries. Arch Int Med (Chic). 1939; 64: 249–267. |
| [7] | DeWood MA, Spores J, Notske R, Mouser LT, Burroughs R, Golden MS, Lang HT. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980; 303: 897–902. doi: 10.1056/NEJM198010163031601. |
| [8] | DeWood MA, Stifter WF, Simpson CS, Spores J, Eugster GS, Judge TP, Hinnen ML. Coronary arteriographic findings soon after non-Qwave myocardial infarction. N Engl J Med. 1986; 315: 417–423. doi: 10.1056/NEJM198608143150703. |
| [9] | Smilowitz NR, Mahajan AM, Roe MT, Hellkamp AS, Chiswell K, Gulati M, Reynolds HR. Mortality of myocardial infarction by sex, age, and obstructive coronary artery disease status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines). Circ Cardiovasc Qual Outcomes. 2017; 10: e003443. doi: 10.1161/CIRCOUTCOMES.116.003443. |
| [10] | Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries [published correction appears in Circulation. 2015; 131: e475]. Circulation. 2015; 131: 861–870. doi: 10.1161/ CIRCULATIONAHA. 114.011201. |
| [11] | Safdar B, Spatz ES, Dreyer RP, Beltrame JF, Lichtman JH, Spertus JA, Reynolds HR, Geda M, Bueno H, Dziura JD, Krumholz HM, D’Onofrio G. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc. 2018; 7: e009174. doi: 10.1161/JAHA.118.009174. |
| [12] | Williams MJ, Barr PR, Lee M, Poppe KK, Kerr AJ. Outcome after myocardial infarction without obstructive coronary artery disease. Heart. 2019 Apr; 105(7): 524–30. |
| [13] | Bainey KR, Welsh RC, Alemayehu W, Westerhout CM, Traboulsi D, Anderson T, et al. Population-level incidence and outcomes of myocardial infarction with non-obstructive coronary arteries (MINOCA): insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study. Int J Cardiol. 2018 Aug; 264: 12–7. |
| [14] | Kilic S, Aydın G, Coner A, Doğan Y, Arican Ozluk O, Celik Y, et al.; MINOCA-TR. Prevalence and clinical profile of patients with myocardial infarction with non-obstructive coronary arteries in Turkey (MINOCA-TR): A national multi-center, observational study. Anatol J Cardiol. 2020 Feb; 23(3): 176–82. |
| [15] | Raparelli V, Elharram M, Shimony A, Eisenberg MJ, Cheema AN, Pilote L. Myocardial Infarction with No Obstructive Coronary Artery Disease: Angiographic and Clinical Insights in Patients with Premature Presentation. Can J Cardiol. 2018 Apr; 34(4): 468–76. |
| [16] | Rakowski T, De Luca G, Siudak Z, Plens K, Dziewierz A, Kleczyński P, et al. Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland: data from the ORPKI national registry. J Thromb Thrombolysis. 2019 Apr; 47(3): 462–6. |
| [17] | Barr PR, Harrison W, Smyth D, Flynn C, Lee M, Kerr AJ. Myocardial Infarction Without Obstructive Coronary Artery Disease is Not a Benign Condition (ANZACS-QI 10). Heart Lung Circ. 2018 Feb; 27(2): 165–74. |
| [18] | Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM, Lerman A, Cushman M, Kumbhani DJ, Arslanian-Engoren C, Bolger AF, Beltrame JF, American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Quality of Care and Outcomes Research. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation 2019; 139: e891-e908. |
| [19] | Daniel M, Agewall S, Berglund F, Caidahl K, Collste O, Ekenb.ck C, et al. Prevalence of Anxiety and Depression Symptoms in Patients with Myocardial Infarction with Non- Obstructive Coronary Arteries. Am J Med. 2018 Sep; 131(9): 1118–24. |
| [20] | Daniel M, Agewall S, Caidahl K, Collste O, Ekenb.ck C, Frick M, et al. Effect of Myocardial Infarction with Nonobstructive Coronary Arteries on Physical Capacity and Quality- of-Life. Am J Cardiol. 2017 Aug; 120(3): 341–6. |
| [21] | Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD: the Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018; 138: e618–e651. doi: 10.1161/CIR.0000000000000617. |
APA Style
Fethi, M., Aoul Radia, T., Tani Abderrahime, M. (2023). Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA). International Journal of Cardiovascular and Thoracic Surgery, 9(6), 84-91. https://doi.org/10.11648/j.ijcts.20230906.13
ACS Style
Fethi, M.; Aoul Radia, T.; Tani Abderrahime, M. Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA). Int. J. Cardiovasc. Thorac. Surg. 2023, 9(6), 84-91. doi: 10.11648/j.ijcts.20230906.13
AMA Style
Fethi M, Aoul Radia T, Tani Abderrahime M. Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA). Int J Cardiovasc Thorac Surg. 2023;9(6):84-91. doi: 10.11648/j.ijcts.20230906.13
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Download@article{10.11648/j.ijcts.20230906.13,
author = {Moussaoui Fethi and Tabet Aoul Radia and Meziane Tani Abderrahime},
title = {Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA)},
journal = {International Journal of Cardiovascular and Thoracic Surgery},
volume = {9},
number = {6},
pages = {84-91},
doi = {10.11648/j.ijcts.20230906.13},
url = {https://doi.org/10.11648/j.ijcts.20230906.13},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20230906.13},
abstract = {Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) remains a puzzling clinical entity characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis Methods and Results: Descriptive, prospective study, spread over a period of 36 months from January 2018 to December 2020 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen, for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (MI-CAD) if there was revascularization or plaque ≥ 50% and as having MINOCA if there was Conclusions: The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (MI- CAD) however they had a better quality of life and a good prognosis.
},
year = {2023}
}
TY - JOUR T1 - Epidemiological Profile of Myocardial Infarction with Non-Significant Stenosis of Coronary Arteries (MINOCA) AU - Moussaoui Fethi AU - Tabet Aoul Radia AU - Meziane Tani Abderrahime Y1 - 2023/12/28 PY - 2023 N1 - https://doi.org/10.11648/j.ijcts.20230906.13 DO - 10.11648/j.ijcts.20230906.13 T2 - International Journal of Cardiovascular and Thoracic Surgery JF - International Journal of Cardiovascular and Thoracic Surgery JO - International Journal of Cardiovascular and Thoracic Surgery SP - 84 EP - 91 PB - Science Publishing Group SN - 2575-4882 UR - https://doi.org/10.11648/j.ijcts.20230906.13 AB - Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) remains a puzzling clinical entity characterized by clinical evidence of myocardial infarction (MI) with normal or near-normal coronary arteries on angiography (stenosis Methods and Results: Descriptive, prospective study, spread over a period of 36 months from January 2018 to December 2020 involving a total number of 585 patients undergoing coronary angiography at the cardiology department of CHU Tlemcen, for a reason for acute myocardial ischemia. We defined the patients as having acute myocardial ischemia with obstructive coronary artery disease (MI-CAD) if there was revascularization or plaque ≥ 50% and as having MINOCA if there was Conclusions: The patients with MINOCA were more men, smokers, depressed, stressed, drug addicts with hypercoagulable states compared to patients with obstructive coronary artery disease (MI- CAD) however they had a better quality of life and a good prognosis. VL - 9 IS - 6 ER -
Department of Cardiology, CHU of Tlemcen, Faculty of Medicine of Tlemcen, Algeria
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