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J Am Heart Assoc. 2018 Jun 28;7(13). pii: e009174. doi: 10.1161/JAHA.118.009174.

Presentation, Clinical Profile, and Prognosis of Young Patients With Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study.

Author information

1
Department of Emergency Medicine, Yale University, New Haven, CT basmah.safdar@yale.edu.
2
Section of Cardiovascular Medicine, Department of Medicine, Yale University, New Haven, CT.
3
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
4
Department of Emergency Medicine, Yale University, New Haven, CT.
5
Queen Elizabeth Hospital, University of Adelaide, Australia.
6
Yale School of Public Health, New Haven, CT.
7
University of Missouri Kansas City, Kansas City, MO.
8
Saint Luke's Mid America Heart Institute, Kansas City, MO.
9
Cardiovascular Clinical Research Center, NYU School of Medicine, New York, NY.
10
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
11
Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain.
12
Facultad de Medicina, Universidad Complutense de Madrid, Spain.

Abstract

BACKGROUND:

We compared the clinical characteristics and outcomes of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) versus obstructive disease (myocardial infarction due to coronary artery disease [MI-CAD]) and among patients with MINOCA by sex and subtype.

METHODS AND RESULTS:

Between 2008 and 2012, VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) prospectively enrolled acute myocardial infarction patients aged 18 to 55 years in 103 hospitals at a 2:1 ratio of women to men. Using an angiographically driven taxonomy, we defined patients as having MI-CAD if there was revascularization or plaque ≥50% and as having MINOCA if there was <50% obstruction or a nonplaque mechanism. Patients who did not have an angiogram or who received thrombolytics before an angiogram were excluded. Outcomes included 1- and 12-month mortality and functional (Seattle Angina Questionnaire [SAQ]) and psychosocial status. Of 2690 patients undergoing angiography, 2374 (88.4%) had MI-CAD, 299 (11.1%) had MINOCA, and 17 (0.6%) remained unclassified. Women had 5 times higher odds of having MINOCA than men (14.9% versus 3.5%; odds ratio: 4.84; 95% confidence interval, 3.29-7.13). MINOCA patients were more likely to be without traditional cardiac risk factors (8.7% versus 1.3%; P<0.001) but more predisposed to hypercoaguable states than MI-CAD patients (3.0% versus 1.3%; P=0.036). Women with MI-CAD were more likely than those with MINOCA to be menopausal (55.2% versus 41.2%; P<0.001) or to have a history of gestational diabetes mellitus (16.8% versus 11.0%; P=0.028). The MINOCA mechanisms varied: a nonplaque mechanism was identified for 75 patients (25.1%), and their clinical profiles and management also varied. One- and 12-month mortality with MINOCA and MI-CAD was similar (1-month: 1.1% and 1.7% [P=0.43]; 12-month: 0.6% and 2.3% [P=0.68], respectively), as was adjusted 12-month SAQ quality of life (76.5 versus 73.5, respectively; P=0.06).

CONCLUSIONS:

Young patients with MINOCA were more likely women, had a heterogeneous mechanistic profile, and had clinical outcomes that were comparable to those of MI-CAD patients.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00597922.

KEYWORDS:

acute myocardial infarction; myocardial infarction with nonobstructive coronary arteries; nonobstructive; prognosis; sex; women

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