AMI patients with patent stents had lower in-hospital event rates (2.6%) versus MIOCA (11.8%) and MINOCA (5.4%), but similar long-term MACE-free survival.
Does the clinical profile and prognosis of AMI-PS differ from MIOCA and MINOCA in patients presenting with NSTEMI?
AMI-PS is a distinct clinical entity with a lower rate of in-hospital events but comparable long-term prognosis to MIOCA and MINOCA.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background patients with acute myocardial infarction (AMI) with previously implanted petent stents and no evidence of new obstructive coronary arteries (AMI-PS) are a group not yet characterised. They should be distinguished from acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) and from myocardial infarction with obstructive coronary artery disease (MIOCA). Purpose to assess clinical profile and prognosis of AMI-PS patients compared to MIOCA and MINOCA. Methods we enrolled consecutive patients referred to our Centre from 2017 to 2021 with diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) according to the fourth universal definition of AMI and undergoing coronary angiography during hospitalization. MINOCA patients were defined according to the current European guidelines criteria. Patients were classified into AMI-PS by the absence of an epicardial vessel with ≥50% stenosis and patency of previously implanted stents. Short-term outcomes included a composite of in-hospital death, re-AMI and arrhythmias. Long-term outcomes was a composite endpoint of MACE (all-cause mortality, re-infarction, stroke and hospitalization for heart failure). Results a total of 2311 patients were recruited (MIOCA: n= 2032; MINOCA: n= 239; AMI-PS: n= 39). As predictable, patients with AMI-PS showed clinical characteristics and cardiovascular risk profile comparable to MIOCA counterpart. Specifically, they were older and with a higher prevalence of hypertension, type-2 diabetes, dyslipidaemia, history of or current smoking, kidney disease, and peripheral arterial disease. Furthermore, due to their prior stent implantation, this subgroup more frequently received secondary prevention and cardioprotective treatments at the time of the event, such as single or dual antiplatelet therapy, statins, β-blockers, and renin–angiotensin–aldosterone system (RAAS) inhibitors. Short-term outcome during hospitalization was better in AMI-PS compared to MIOCA and MINOCA group, indeed intra-hospital events were respectively 2.6% vs 11.8% vs 5.4% (p=0.003). At a median follow-up of 46 months, Kaplan Meier curves showed that there were no differences among the three groups regarding MACE-free survival (p=ns). Conclusions AMI-PS is a not well known nosological entity with comparable clinical features and prognosis to MIOCA despite the presence of patency stent but with a lower rate of intra-hospital events. Nevertheless, further studies are needed to understand the pathophysiological significance of myocardial infarction in this population and subsequent to optimize therapeutic management.
Amicone et al. (Sat,) reported a other. AMI patients with patent stents had lower in-hospital event rates (2.6%) versus MIOCA (11.8%) and MINOCA (5.4%), but similar long-term MACE-free survival.