1Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 2Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 3Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland; 4Kath. Klinikum Bochum Cellular Physiology Bochum, Deutschland; 5Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland
background: Several data have been published regarding the prevalence, risk factors related to predisposition, and prognosis of patients suffering from myocardial infarction with non-obstructive coronary disease (MINOCA). However, many aspects of this condition, such as its pathophysiology, remain poorly understood. The purpose of this study was to examine the baseline characteristics and in-hospital complications of MINOCA patients.
methods and results: Our institutional database consisted of a cohort of 373 patients diagnosed with troponin elevation with no obstructive coronary artery disease “MINOCA” between 2010 to 2021. The endpoint of this study was a composite of in-hospital events, including stroke, cardiopulmonary resuscitation, cardiogenic shock, pulmonary edema, invasive ventilation, left ventricular thrombus, thromboembolic events, malignant cardiac arrhythmias, supraventricular arrhythmias and in-hospital death. In addition, we evaluated out of hospital cardiovascular events over follow up.
The mean age was 63 ± 15.6 years and the sex ratio was balanced (49.6% men). The mean troponin value was 0.1±1.2 µg/l and the BNP value 16±34.4 pmol/l. The most commodities included neurological disease (24.3%) and cancer (12.7%) in addition to dominant cardiovascular risk factors such as arterial hypertension (68.2%), dyslipidaemia (26.6%), diabetes mellitus (17.5%), and atrial fibrillation (15.4%). The mean left ventricular ejection fraction was 36.9±25.7% (170 patients HFpEF, 31 HFmrEF and 52 HFrEF). On admission, patients presented predominantly with angina (61.8%) and dyspnea (44.6%). The most common in-hospital events were cardiopulmonary resuscitation (1.9%), cardiogenic shock (2.4%), pulmonary edema (2.4%), invasive (7.8%) and non-invasive ventilation (3%), malignant cardiac arrhythmias (10.5%), supraventricular arrhythmias (23%) and in-hospital death (2.7%).
Our multivariate Cox regression for in-hospital events revealed that arterial hypertension (Hazard ratio (HR) 2.1, 95 % Confidence interval (CI): 1-4.4, p<0.05), supraventricular tachycardia (HR 3.5, 95 % CI: 1.1-5.8, p<0.05), an ejection fraction (EF) 49-40% (HR 2.9, 95% CI: 1.2-7.1, p<0.05), and an EF less than 40% (HR 3.4, 95% CI: 1.6-7.1, p<0.05) were significant independent positive predictors of in-hospital events and free thyroxine (fT4) <10 pmol/l was a significant independent negative predictor of in-hospital events.
At follow-up of 6±3 years the rate of long term outcome (stroke, thromboembolic events, recurrence of troponin-positive with non-obstructive coronary artery disease and percutaneous coronary intervention subsequently, cardiac arrest and all-cause mortality) revealed 34.8%.
Conclusion: MINOCA patients suffer from significant in-hospital complications and cardiovascular events over follow-up. This cohort predisposes a high-risk patient group and follow-up is required also in case of a not reduced left ventricular ejection fraction.