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Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA)

Authors :
Giulia Magnani
Serena Bricoli
Maddalena Ardissino
Giuseppe Maglietta
Adam Nelson
Guidantonio Malagoli Tagliazucchi
Caterina Disisto
Patrizia Celli
Maurizio Ferrario
Umberto Canosi
Carlo Cernetti
Francesco Negri
Piera Angelica Merlini
Marco Tubaro
Carlo Berzuini
Chiara Manzalini
Gianfranco Ignone
Carlo Campana
Luigi Moschini
Elisabetta Ponte
Roberto Pozzi
Raffaela Fetiveau
Silvia Buratti
Elvezia Paraboschi
Rosanna Asselta
Andrea Botti
Domenico Tuttolomondo
Federico Barocelli
Andrea Biagi
Rosario Bonura
Tiziano Moccetti
Antonio Crocamo
Giorgio Benatti
Giorgia Paoli
Emilia Solinas
Maria Francesca Notarangelo
Elisabetta Moscarella
Paolo CalabrĂ²
Stefano Duga
Giampaolo Niccoli
Diego Ardissino
Source :
International journal of cardiology. 354
Publication Year :
2022

Abstract

Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting.The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation.MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p 0.001).MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.

Details

ISSN :
18741754
Volume :
354
Database :
OpenAIRE
Journal :
International journal of cardiology
Accession number :
edsair.doi.dedup.....e3e0bac86be709c919b51807efeffaff