Assessment of a New Electrocardiographic Marker for the Diagnosis of Myocardial Infarction With Non-obstructive Coronary Arteries

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is clinically defined as myocardial infarction in the absence of obstructive atherosclerosis on coronary angiography. Diagnosis may require multiple diagnostic tools in addition to standard coronary angiography, including cardiac imaging or provocative tests, according to clinical suspicion. We assessed the usefulness of the DETERMINE (Defibrillators to Reduce Risk by Magnetic Resonance Imaging Evaluation) score for distinguishing patients with MINOCA from those with non-ST segment elevation myocardial infarction with obstructive coronary artery disease (NSTEMI-CAD) in a single-center observational study. The patients were divided into two groups according to coronary angiography findings. The study included 277 patients: 227 with NSTEMI-CAD and 50 with MINOCA. The DETERMINE score (6.1 ± 3.7 vs 1.9 ± 2.1, P<.001) was significantly higher in the NSTEMI-CAD than MINOCA group. Logistic regression analysis revealed that the DETERMINE score (OR=0.591, P<0.001) was an independent predictor of MINOCA. The incidence of diabetes mellitus and glucose levels were significantly higher in the NSTEMI-CAD group; however, ejection fraction was significantly higher in the MINOCA group (P<0.05). Our findings suggest that the DETERMINE score constitutes a simple and inexpensive tool for the assessment of MINOCA.