A structured diagnostic protocol established final diagnoses in 62% of MINOCA patients with no sex difference, despite differences in testing modalities used.
Does the diagnostic work-up and diagnostic yield of protocolized diagnostics for MINOCA differ between male and female patients?
Despite sex differences in the utilization of specific diagnostic modalities for MINOCA, a structured diagnostic protocol yields a final diagnosis in approximately 62% of patients regardless of sex.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a diagnostic and therapeutic challenge, as the underlying cause is often not easily identifiable. Therefore, a structured diagnostic work-up is recommended. Currently, there is little data available regarding sex differences in MINOCA. Purpose This study aims to assess the differences in real-world diagnostic work-up and diagnostic yield between male and female patients. Methods In this multicenter cohort study, we retrospectively analyzed all patients meeting the diagnostic criteria for MINOCA undergoing coronary angiography at a university hospital between December 2020 and June 2024. If a working diagnosis of MINOCA was considered after conventional coronary angiography, local protocol recommends ad-hoc optical coherence tomography (OCT) and cardiac magnetic resonance (CMR) imaging after one week. Left ventricular angiography (LVA) and echocardiography are considered for screening for alternative causes, while coronary functional testing (CFT) is conducted only in cases of persistent angina. Results A total of 183 patients were included. Median age was 63 years (interquartile range 25-90) and 60% of patients was female. ST-deviation was more common in male patients vs female patients (34% vs 18%, p=0.02), including ST-segment elevation in 22% and 12%, respectively (p=0.08). LVA and echocardiography were performed in 5% of males vs 16% of females (p=0.03) and 61% of males vs 50% in females (p=0.17). OCT was performed in 73% of the male patients vs 53% of the female patients (p=0.007). CMR was performed in comparable proportion of patients (55% male vs 58% female, p=0.75). CFT was performed in two (female) patients. Based on this protocol, a final diagnosis was established in 62% of cases, with no difference between sexes (64% in males vs 61% in females, p=0.69). The diagnostic yield per modality is as follows. Using the definition proposed by Reynolds et al., a culprit was detected with OCT in 35% and 29% (male vs female respectively, p=0.51). Takotsubo was diagnosed in 9% and 44% (male vs female respectively, p0.001) using LVA or cardiac ultrasound. Causes detected by CMR included myocardial infarction (43% male vs 47% female, p=0.77), myocarditis (30% male vs 15% female, p=0.14), non-ischemic cardiomyopathy (23% male vs 12% female, p=0.22), Takotsubo cardiomyopathy (0% male vs 15% female, p=0.029) and other cardiomyopathy (3% male vs 12% female, p=0.21). One female patient was diagnosed with epicardial spasm by CFT. Conclusions In this contemporary cohort of MINOCA patients, differences in diagnostic work-up were observed between sexes. Nevertheless, the overall diagnostic yield of our structured diagnostic protocol was comparable between male and female patients, with a final diagnosis in 62% of the cases. Improved adoption of diagnostic modalities may improve the diagnostic yield in both sexes.
Yosofi et al. (Sat,) reported a other. A structured diagnostic protocol established final diagnoses in 62% of MINOCA patients with no sex difference, despite differences in testing modalities used.