Abstract 13384: Prognosis of Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries as Compared With Obstructive Coronary Disease
Introduction: The prognosis of patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is poorly understood. We examined the prevalence of adverse events (mortality, re-infarction and readmission) in patients with MINOCA over 1 year versus patients with acute myocardial infarction (AMI) and obstructive coronary artery disease (MICAD).
Methods: Between July 2009 and December 2010, both patients with STEMI and NSTEMI, aged >65 years, from the National Cardiovascular Data Registry (NCDR®) CathPCI Registry were classified as having either obstructive or non-obstructive CAD (n=570,219) on the basis of their angiographic reports revealing no epicardial vessel with stenosis ≥50% (MINOCA) or at least one stenosis ≥50% (MICAD). Re-hospitalizations, repeat AMI, and mortality were assessed via linkage to Medicare data. We had the following exclusion criteria: (a) patients presenting with cardiac arrest within 24 hours (n=3,510), (b) patients with AMI as a complication during hospitalization (n=1,751), and (c) patients not in the Medicare data, or that could not be matched with Medicare through the patient beneficiary ID and discharge date (n=469,722). Analyses comparing MINOCA and MICAD were performed using the chi-squared test for categorical variables and the T-test for continuous variables.
Results: Among 95,236 AMI patients, 4,831 patients (5.1%) had MINOCA. Compared to those with MICAD, patients with MINOCA were younger (75±7 vs 76±7, P<0.001), more likely to be female (78% vs 42%, P<0.001), and were predominately white (89% vs 91%, P<0.001). Outcomes over 1 year are described in the Table.
Conclusion: In an elderly AMI population, the occurrence of MINOCA accounts for 5% of AMI presentations. Although MINOCA patients had fewer adverse events over 1 year compared with MICAD patients, they remain at modest to high risk for readmission and mortality. Further studies are needed to define whether or not these events are preventable.
Author Disclosures: R.P. Dreyer: None. R. Tavella: None. J.P. Curtis: Other; Modest; Salary support from the American College of Cardiology. Y. Wang: None. S. Pauspathy: None. J. Messenger: None. J.S. Rumsfeld: Other; Modest; Chief Innovation Officer for the ACC. T.M. Maddox: None. H.M. Krumholz: Research Grant; Modest; U01 HL105270-05 (Center for Cardiovascular Outcomes Research at Yale University) from NHLBI. Other Research Support; Modest; Recipient of research agreements from Medtronic, Inc, and Johnson & Johnson (Janssen) through Yale University to develop methods of clinical trial data sharing. Consultant/Advisory Board; Modest; Chair of a cardiac scientific advisory board for UnitedHealth. J.A. Spertus: Research Grant; Modest; Supported by grants from Gilead, Genentech, Lilly, Amorcyte, and EvaHeart. J.F. Beltrame: None.
- © 2016 by American Heart Association, Inc.