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Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers

IMPORTANCE: The clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown. OBJECTIVE: To assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimi...

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Autores principales: Quesada, Odayme, Yildiz, Mehmet, Henry, Timothy D., Bergstedt, Seth, Chambers, Jenny, Shah, Ananya, Stanberry, Larissa, Volpenhein, Lucas, Aziz, Dalia, Lantz, Rebekah, Palmer, Cassady, Ugwu, Justin, Ahsan, Muhammad J., Garberich, Ross F., Rohm, Heather S., Aguirre, Frank V., Garcia, Santiago, Sharkey, Scott W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654797/
https://www.ncbi.nlm.nih.gov/pubmed/37971742
http://dx.doi.org/10.1001/jamanetworkopen.2023.43402
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author Quesada, Odayme
Yildiz, Mehmet
Henry, Timothy D.
Bergstedt, Seth
Chambers, Jenny
Shah, Ananya
Stanberry, Larissa
Volpenhein, Lucas
Aziz, Dalia
Lantz, Rebekah
Palmer, Cassady
Ugwu, Justin
Ahsan, Muhammad J.
Garberich, Ross F.
Rohm, Heather S.
Aguirre, Frank V.
Garcia, Santiago
Sharkey, Scott W.
author_facet Quesada, Odayme
Yildiz, Mehmet
Henry, Timothy D.
Bergstedt, Seth
Chambers, Jenny
Shah, Ananya
Stanberry, Larissa
Volpenhein, Lucas
Aziz, Dalia
Lantz, Rebekah
Palmer, Cassady
Ugwu, Justin
Ahsan, Muhammad J.
Garberich, Ross F.
Rohm, Heather S.
Aguirre, Frank V.
Garcia, Santiago
Sharkey, Scott W.
author_sort Quesada, Odayme
collection PubMed
description IMPORTANCE: The clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown. OBJECTIVE: To assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimickers as compared with obstructive disease. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of a prospective registry-based cohort study of consecutive STEMI activations at 3 regional Midwest STEMI programs. STEMI without a culprit artery and elevated troponin levels were categorized as MINOCA (absence of coronary artery stenosis >50% and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) or MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy). Data were analyzed from March 2003 to December 2020. MAIN OUTCOMES AND MEASURES: Adjusted Cox regression analysis was used to assess 5-year mortality risk in STEMI presenting with MINOCA and MINOCA mimickers in comparison with obstructive disease. RESULTS: Among 8560 consecutive patients with STEMI, mean (SD) age was 62 (14) years, 30% were female (2609 participants), and 94% were non-Hispanic White (4358 participants). The cohort included 8151 patients with STEMI due to obstructive disease (95.2%), 120 patients with MINOCA (1.4%), and 289 patients with MINOCA mimickers (3.8%). Patients were followed up for a median (IQR) of 7.1 (3.6-10.7) years. Patients with MINOCA and MINOCA mimickers were less likely to be discharged with cardiac medications compared with obstructive disease. At 5-year follow-up, mortality in STEMI presenting with obstructive disease (1228 participants [16%]) was similar to MINOCA (20 participants [18%]; χ(2)(1) = 1.1; log-rank P = .29) and MINOCA mimickers (52 participants [18%]; χ(2)(1) = 2.3; log-rank P = .13). In adjusted Cox regression analysis compared with obstructive disease, the 5-year mortality hazard risk was 1.93 times higher in MINOCA (95% CI, 1.06-3.53) and similar in MINOCA mimickers (HR, 1.08; 95% CI, 0.79-1.49). CONCLUSIONS AND RELEVANCE: In this large multicenter cohort study of consecutive clinical patients with STEMI, presenting with MINOCA was associated with a higher risk of mortality than obstructive disease; the risk of mortality was similar in patients with MINOCA mimickers and obstructive disease. Further investigation is necessary to understand the pathophysiologic mechanisms involved in this high-risk STEMI population.
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spelling pubmed-106547972023-11-16 Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers Quesada, Odayme Yildiz, Mehmet Henry, Timothy D. Bergstedt, Seth Chambers, Jenny Shah, Ananya Stanberry, Larissa Volpenhein, Lucas Aziz, Dalia Lantz, Rebekah Palmer, Cassady Ugwu, Justin Ahsan, Muhammad J. Garberich, Ross F. Rohm, Heather S. Aguirre, Frank V. Garcia, Santiago Sharkey, Scott W. JAMA Netw Open Original Investigation IMPORTANCE: The clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown. OBJECTIVE: To assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimickers as compared with obstructive disease. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of a prospective registry-based cohort study of consecutive STEMI activations at 3 regional Midwest STEMI programs. STEMI without a culprit artery and elevated troponin levels were categorized as MINOCA (absence of coronary artery stenosis >50% and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) or MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy). Data were analyzed from March 2003 to December 2020. MAIN OUTCOMES AND MEASURES: Adjusted Cox regression analysis was used to assess 5-year mortality risk in STEMI presenting with MINOCA and MINOCA mimickers in comparison with obstructive disease. RESULTS: Among 8560 consecutive patients with STEMI, mean (SD) age was 62 (14) years, 30% were female (2609 participants), and 94% were non-Hispanic White (4358 participants). The cohort included 8151 patients with STEMI due to obstructive disease (95.2%), 120 patients with MINOCA (1.4%), and 289 patients with MINOCA mimickers (3.8%). Patients were followed up for a median (IQR) of 7.1 (3.6-10.7) years. Patients with MINOCA and MINOCA mimickers were less likely to be discharged with cardiac medications compared with obstructive disease. At 5-year follow-up, mortality in STEMI presenting with obstructive disease (1228 participants [16%]) was similar to MINOCA (20 participants [18%]; χ(2)(1) = 1.1; log-rank P = .29) and MINOCA mimickers (52 participants [18%]; χ(2)(1) = 2.3; log-rank P = .13). In adjusted Cox regression analysis compared with obstructive disease, the 5-year mortality hazard risk was 1.93 times higher in MINOCA (95% CI, 1.06-3.53) and similar in MINOCA mimickers (HR, 1.08; 95% CI, 0.79-1.49). CONCLUSIONS AND RELEVANCE: In this large multicenter cohort study of consecutive clinical patients with STEMI, presenting with MINOCA was associated with a higher risk of mortality than obstructive disease; the risk of mortality was similar in patients with MINOCA mimickers and obstructive disease. Further investigation is necessary to understand the pathophysiologic mechanisms involved in this high-risk STEMI population. American Medical Association 2023-11-16 /pmc/articles/PMC10654797/ /pubmed/37971742 http://dx.doi.org/10.1001/jamanetworkopen.2023.43402 Text en Copyright 2023 Quesada O et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Quesada, Odayme
Yildiz, Mehmet
Henry, Timothy D.
Bergstedt, Seth
Chambers, Jenny
Shah, Ananya
Stanberry, Larissa
Volpenhein, Lucas
Aziz, Dalia
Lantz, Rebekah
Palmer, Cassady
Ugwu, Justin
Ahsan, Muhammad J.
Garberich, Ross F.
Rohm, Heather S.
Aguirre, Frank V.
Garcia, Santiago
Sharkey, Scott W.
Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title_full Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title_fullStr Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title_full_unstemmed Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title_short Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers
title_sort mortality in st-segment elevation myocardial infarction with nonobstructive coronary arteries and mimickers
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654797/
https://www.ncbi.nlm.nih.gov/pubmed/37971742
http://dx.doi.org/10.1001/jamanetworkopen.2023.43402
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