What is the clinical evidence from this study?

Study design: Observational. Population: Myocardial infarction (n=1626). Intervention: Myocardial infarction with non-obstructive coronary arteries (MINOCA) vs. Myocardial infarction with obstructive coronary artery disease (non-MINOCA). Primary outcome: Prevalence of MINOCA.

January 1, 2019The Anatolian Journal of Cardiology30 citationsOpen Access

Prevalence and Clinical Profile of Patients with Myocardial Infarction with Non-obstructive Coronary Arteries in Turkey (MINOCA-TR): A national multi-centre, observational study

SKSalih KılıçIğdır Üniversitesi

Key Result

The prevalence of MINOCA in Turkey was 6.7% among patients admitted with myocardial infarction, and these patients had fewer traditional cardiovascular risk factors compared to non-MINOCA patients.

Study Design

Type

Observational (n=1,626)

Multicenter

Yes

Structured PICO

Population

1,626 adult patients diagnosed with myocardial infarction who underwent coronary angiography across 32 centers in Turkey, evaluated for the prevalence and clinical profile of MINOCA.

Outcome

Prevalence and demographics of MINOCA in a Turkish population

In a Turkish nationwide cohort, MINOCA accounted for 6.7% of myocardial infarctions and was associated with younger age, female sex, and a lower burden of traditional cardiovascular risk factors compared to obstructive MI.

Limitations

MI and MINOCA were defined using the Third Universal Definition of Myocardial Infarction, as the Fourth was published after the study started.
Other possible causes of MINOCA were not assessed during the initial hospitalization due to the observational nature of the study.
Potential underestimation of MINOCA prevalence because lower-risk patients might not have been referred for coronary angiography.
MI and MINOCA were defined in line with the Third Universal Definition of Myocardial Infarction, whereas the Fourth was published after the start date.
Other possible causes of MINOCA were not assessed during the initial hospitalization.
Some patients with a lower burden of CAD risk factors might not have been referred to QCA, resulting in an underestimated prevalence of MINOCA.

Abstract

OBJECTIVE: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population. METHODS: MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded. RESULTS: A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001). CONCLUSION: The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.

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