December 18, 2018Journal of Thrombosis and Thrombolysis54 citationsOpen Access
Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland: data from the ORPKI national registry
Key Result
Patients with MINOCA represented 7.8% of all myocardial infarctions and had significantly lower periprocedural mortality (0.13%) compared to those with obstructive coronary artery disease (0.95%).
Study Design
Type
Observational (n=49,893)
Multicenter
Yes
Structured PICO
What are the clinical characteristics and periprocedural outcomes of patients presenting with MINOCA compared to those with obstructive CAD?
P
Population
49,893 patients with STEMI or NSTEMI enrolled in the Polish National ORPKI Registry in 2016, comparing characteristics and periprocedural outcomes of those with MINOCA versus obstructive coronary artery disease.
C
Comparator
Patients with obstructive coronary artery disease (CAD)
O
Outcome
Clinical characteristics, presentation (NSTEMI vs STEMI), angiographic findings, and periprocedural mortality
MINOCA accounts for nearly 8% of MI presentations in Poland and is associated with a distinct clinical profile, fewer comorbidities, and lower periprocedural mortality compared to obstructive CAD.
Main Result
Absolute Event Rate: 0.13% vs 0.95%
p-value: p=<0.0001
Limitations
- Angiograms were assessed locally by operators, not by an independent image analysis core laboratory.
- The registry does not collect data beyond the cathlab, precluding assessment of further diagnostics, final diagnosis, or follow-up event rates.
- Potential bias from unmeasured confounding factors not included in the analysis.
Abstract
Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is an important clinical problem especially in the era of extensive utilization of coronary angiography in MI patients. Its pathophysiology is poorly understood which makes diagnostics and treatment of MINOCA challenging in everyday clinical practice. The aim of the study was to assess characteristics of MINOCA patients in Poland based on data from the Polish National ORPKI Registry. In 2016, 49,893 patients with non-ST-segment elevation (NSTEMI) or ST-segment elevation (STEMI) myocardial infarction entered the ORPKI registry. MINOCA was defined as a non-obstructive coronary artery disease (CAD) and a lack of previous coronary revascularization. MINOCA was identified in 3924 (7.8%) patients and clinical presentation was more often NSTEMI than STEMI (MINOCA: 78 vs. 22%; obstructive CAD 51.1 vs. 48.9%; p < 0.0001). MINOCA patients were younger and more often females with significantly lower rates of diabetes, smoking, arterial hypertension, kidney disease, previous MI and previous stroke comparing to patients with obstructive CAD. Myocardial bridge was visualized in angiography more often in the MINOCA group (2.2 vs. 0.4%; p < 0.0001). Additional coronary assessment inducing fractional flow reserve, intravascular ultrasound, optical coherence tomography was marginally (< 1%) used in both groups. Periprocedural mortality was lower in MINOCA group (0.13% vs. 0.95%; p < 0.0001). MINOCA patients represent a significant proportion of MI patients in Poland. Due to multiple potential causes, MINOCA should be considered rather as a working diagnosis after coronary angiography and further efforts should be taken to define the cause of MI in each individual patient.
Cite This Study
Rakowski et al. (2018) conducted an observational in Myocardial infarction (n=49,893). Myocardial infarction with non-obstructive coronary arteries (MINOCA) vs. Obstructive coronary artery disease was evaluated on Periprocedural mortality (p=<0.0001). Patients with MINOCA represented 7.8% of all myocardial infarctions and had significantly lower periprocedural mortality (0.13%) compared to those with obstructive coronary artery disease (0.95%).