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Daniel Ballesteros-Ortega,1 Oscar Martínez-González,1 Rafael Blancas Gómez-Casero,1 Manuel Quintana-Díaz,2 Eva de Miguel-Balsa,3 Carmen Martín-Parra,1 Blanca López-Matamala,1 Miriam Chana-García,1 M Ángeles Alonso-Fernández,1 Madián Manso-Álvarez1 On behalf of the ARIAM-SEMICYUC Group 1Critical Care Department, Hospital Universitario del Tajo, CP 28300, Aranjuez, Spain; 2Critical Care Department, Hospital Universitario La Paz, 28046 Madrid, Spain; 3Critical Care Department, Hospital General Universitario de Elche, 03203 Elche, Alicante, Spain Background: Acute myocardial infarction (AMI) with no evidence of relevant stenosis of the coronary artery, known as myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA), has a prevalence of up to 14%. The various causes of MINOCA lead to damage of the myocardium, and there are marked differences in diagnoses, prognoses, and treatments. Although the number of patients affected is considerable owing to the high prevalence of acute coronary syndrome (ACS), the causes of MINOCA have received little attention with the result that some patients may not receive appropriate treatment. Awareness of this disease among clinicians has started only to improve since the beginning of the current century. The aim of this study was to develop a score that enables patients with MINOCA to be distinguished from patients with MI with coronary artery disease (MI-CAD) and thus to facilitate appropriate diagnosis and therapy. Patients and methods: A multicenter observational cohort study was designed. All patients aged ≥18 years from the ARIAM-SEMICYUC (Analysis of Delay in AMI-Spanish Society of Intensive Care Medicine and Coronary Unit) registry, diagnosed with AMI, and admitted to critical care units or coronary care units (CCUs) were included. Patients were classified into two groups: MINOCA, comprising patients with no significant lesions on angiography, and MI-CAD, comprising patients with lesions of the coronary artery tree. Results: A score based on standard variables to assess the probability of MINOCA on admission was designed, showing a maximum value corresponding to a 40% probability of MINOCA. The discriminative power of the model was 0.756 (P-value for the Hosmer–Lemeshow test was >0.05). At 30-day follow-up, the mortality rate was higher for MI-CAD patients. Conclusion: Patients with MINOCA constitute a population that differs from other patients with AMI. Their differential characteristics require a certain diagnostic effort to align therapy with the disease causing the ischemic event. This score could prove useful in establishing additional diagnostic procedures. Keywords: MINOCA, acute myocardial infarction, nonobstructive coronary disease, coronary syndrome, score

Resumen Fundamento y objetivo La frecuencia de la insuficiencia ventricular izquierda ( IVI ) en las fases precoces del sindrome coronario agudo sin elevacion del segmento ST (SCASEST) no esta descrita en la actualidad. El objetivo de este estudio es describir por vez primera la frecuencia de esta complicacion en la evolucion inicial del SCASEST y evaluar su asociacion a otras intervenciones. Pacientes y metodo Estudio observacional de cohortes prospectivo y multicentrico realizado en unidades de cuidados intensivos y coronarios (UCIC). Se incluyeron pacientes con SCASEST ingresados en las primeras 24 h de evolucion. El desenlace principal fue la aparicion de IVI . Se evaluo la asociacion entre esta y variables clinicas y terapeuticas. Resultados Se produjo IVI en el 15,6% de los pacientes. La realizacion de angiografia coronaria (AC) durante el ingreso en la UCIC fue una variable protectora frente al desenlace principal, realizada tanto antes de las 72 horas ( odds ratio [OR] 0,47; intervalo de confianza del 95% [IC 95%] 0,25-0,89; p = 0,022), como mas tarde (OR 0,39; IC 95% 0,15-0,98; p = 0,044). La administracion de betabloqueantes se mostro como variable protectora frente a la aparicion de IVI (OR 0,54; IC 95% 0,32-0,87; p = 0,013). La toma de acido acetilsalicilico antes del ingreso en la UCIC supuso un mayor riesgo de IVI (OR 1,74; IC 95% 1,06-2,86; p = 0,028). La edad fue factor de riesgo de presentar IVI (OR 1,02; IC 95% 1,00-1,05; p = 0,032). Conclusiones La realizacion de AC precoz y la administracion de betabloqueantes aparecen como capaces de disminuir la aparicion de IVI . La toma previa de acido acetilsalicilico y la edad se asociaron a la aparicion de IVI , pudiendo reflejar enfermedad cardiovascular de larga evolucion.

The frequency of left ventricular failure (LVF) in the early stages of non-ST-segment elevation acute coronary syndrome (NSTE ACS) has not been described so far. The objective of this study is to describe for the first time the frequency of LVF in the early course of NSTE ACS and to assess its association with other interventions.Observational prospective cohort multicenter study in intensive and coronary care units (ICCU). Patients with NSTE ACS admitted within 24h after onset were included. Main outcome was the occurrence of LVF. We evaluated the association between LVF and clinical and therapeutic variables.LVF occurred in 15.6% of patients. Coronary angiography (CA) during admission to the ICCU was a protective variable against the main outcome, performed before 72h (odds ratio [OR] 0.47; 95% confidence interval [95% CI] 0.25-0.89; P=.022) and later (OR 0,39; 95% CI 0,15-0,98; P=.044). The administration of beta-blockers was a protective variable against the occurrence of LVF (OR 0,54; 95% CI 0,32-0,87; P=.013). Patients receiving acetylsalicylic acid before admission to the ICCU had a higher risk of developing LVF (OR 1.74; 95% CI 1.06-2.86; P=.028). Age was also a factor of risk for LVF (OR 1.02; 95% CI 1.00-1.05; P=.032).CA and beta-blockers can decrease the occurrence of LVF. The association between previous administration of acetylsalicylic acid and age with the occurrence of LVF may reflect long-standing cardiovascular disease.