Background: 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. Methods: 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. Results: 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). Conclusions: 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.

Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA) / Magnani, G.; Bricoli, S.; Ardissino, M.; Maglietta, G.; Nelson, A.; Malagoli Tagliazucchi, G.; Disisto, C.; Celli, P.; Ferrario, M.; Canosi, U.; Cernetti, C.; Negri, F.; Merlini, P. A.; Tubaro, M.; Berzuini, C.; Manzalini, C.; Ignone, G.; Campana, C.; Moschini, L.; Ponte, E.; Pozzi, R.; Fetiveau, R.; Buratti, S.; Paraboschi, E.; Asselta, R.; Botti, A.; Tuttolomondo, D.; Barocelli, F.; Biagi, A.; Bonura, R.; Moccetti, T.; Crocamo, A.; Benatti, G.; Paoli, G.; Solinas, E.; Notarangelo, M. F.; Moscarella, E.; Calabro, P.; Duga, S.; Niccoli, G.; Ardissino, D.. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 354:(2022), pp. 7-13. [10.1016/j.ijcard.2022.02.015]

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

Bricoli S.;Manzalini C.;Campana C.;Moschini L.;Buratti S.;Botti A.;Tuttolomondo D.;Barocelli F.;Biagi A.;Bonura R.;Crocamo A.;Benatti G.;Paoli G.;Niccoli G.;Ardissino D.
2022-01-01

Abstract

Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA) / Magnani, G.; Bricoli, S.; Ardissino, M.; Maglietta, G.; Nelson, A.; Malagoli Tagliazucchi, G.; Disisto, C.; Celli, P.; Ferrario, M.; Canosi, U.; Cernetti, C.; Negri, F.; Merlini, P. A.; Tubaro, M.; Berzuini, C.; Manzalini, C.; Ignone, G.; Campana, C.; Moschini, L.; Ponte, E.; Pozzi, R.; Fetiveau, R.; Buratti, S.; Paraboschi, E.; Asselta, R.; Botti, A.; Tuttolomondo, D.; Barocelli, F.; Biagi, A.; Bonura, R.; Moccetti, T.; Crocamo, A.; Benatti, G.; Paoli, G.; Solinas, E.; Notarangelo, M. F.; Moscarella, E.; Calabro, P.; Duga, S.; Niccoli, G.; Ardissino, D.. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 354:(2022), pp. 7-13. [10.1016/j.ijcard.2022.02.015]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2922355
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