Characteristics of patients with recurrent acute myocardial infarction after MINOCA. in Progress in cardiovascular diseases / Prog Cardiovasc Dis. 2023 Oct 16:S0033-0620(23)00109-3. doi: 10.1016/j.pcad.2023.10.006.
2023
ASL Biella
Tipo pubblicazione
Journal Article
Autori/Collaboratori (29)Vedi tutti...
Ciliberti G
Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy. Electronic address: ciliberti.giuseppe@libero.it.
Guerra F
Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
Pizzi C
Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy.
et alii...
Abstract
BACKGROUND: Myocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined. METHODS: In this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI. RESULTS: 54 patients (mean age 66?±?13) experienced a subsequent re-AMI after MINOCA and subsequent follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n?=?695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p?=?0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p?=?0.049). Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30-49%), and 41.7% showed obstructive coronary atherosclerosis (?50% stenosis). Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55?mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up. CONCLUSIONS: In the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population.
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PMID : 37852517
DOI : 10.1016/j.pcad.2023.10.006
Keywords
Coronary angiography; Acute myocardial infarction; MINOCA; Outcomes;