Why the study?
Clinical trials are lacking to guide medical management for MINOCA and INOCA, and data on long-term outcomes following attendance at a specialized women's heart centre are lacking.
Does comprehensive care at a specialized women's heart centre improve clinical outcomes and patient-reported well-being in women with MINOCA and INOCA?
Does comprehensive care at a specialized women's heart centre improve clinical outcomes and patient-reported well-being in women with MINOCA and INOCA?
A specialized women's heart centre care model for MINOCA and INOCA is associated with reduced hospital encounters and improved angina-related quality of life over 3 years.
May support specialized care models for MINOCA/INOCA women; hypothesis-generating and requires randomized confirmation before practice change.
Abstract Background Myocardial infarction with no obstructive coronary arteries (MINOCA), and ischemia with no obstructive coronary arteries (INOCA), are female-predominant conditions; clinical trials are lacking to guide medical management for the common underlying vasomotor etiologies. Data on long-term outcomes of (M)INOCA patients following attendance at a women's heart centre (WHC) are lacking. Methods Women diagnosed with MINOCA (n = 51) or INOCA (n = 112) were prospectively followed for 3 years at the Leslie Diamond WHC (LDWHC) in Vancouver. Baseline characteristics, diagnoses, chest-pain type, major adverse cardiac events, hospital encounters, medications, and Seattle Angina Questionnaire (SAQ) responses were compared between the baseline and 3-year timepoints. The χ² test was used to compare categorical variables; the Student t test was used for continuous variables. Results MINOCA patients had significantly more nonexertional chest pain and more diagnoses of vasospasm than did INOCA patients, who had more exertional chest pain and more diagnoses of coronary microvascular dysfunction. Following the baseline timepoint, both groups had significant reductions in cardiovascular emergency room visits, with INOCA patients also experiencing fewer cardiovascular hospitalizations. At 3 years, the most commonly prescribed medications were calcium-channel blockers, long-acting nitrates, and beta-blockers, with MINOCA patients having more acetylsalicylic acid use, and INOCA patients having more short-acting nitrate and ranolazine prescriptions. Both groups observed significant improvements in SAQ scores, with greater improvements observed in INOCA patients. Patients with depression or who were prescribed ranolazine at 3 years had worse SAQ scores at baseline. Conclusions The 3-year outcomes of (M)INOCA patients indicate that the LDWHC's comprehensive care model effectively improves diagnostic clarity, reduces the number of hospital encounters, optimizes medication management, and improves self-reported patient well-being.
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Théberge et al. (2024) studied this question.
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