Characteristics of patients with recurrent acute myocardial infarction after MINOCA

Giuseppe Ciliberti; Federico Guerra; Carmine Pizzi; Marco Merlo; Filippo Zilio; Francesco Bianco; Massimo Mancone; Denise Zaffalon; Rocco Gioscia; Luca Bergamaschi; Paolo Compagnucci; Matteo Armillotta; Michela Casella; Angelo Sansonetti; Marco Marini; Pasquale Paolisso; Giulia Stronati; Sabina Gallina; Antonio Dello Russo; Gian Piero Perna; Francesco Fedele; Roberto Bonmassari; Giuseppe De Luca; Isabella Tritto; Tommaso Piva; Gianfranco Sinagra; Giuseppe Ambrosio; Juan Carlos Kaski; Monica Verdoia

doi:10.1016/j.pcad.2023.10.006

Characteristics of patients with recurrent acute myocardial infarction after MINOCA

Prog Cardiovasc Dis. 2023 Nov-Dec:81:42-47. doi: 10.1016/j.pcad.2023.10.006. Epub 2023 Oct 16.

Authors

Giuseppe Ciliberti¹, Federico Guerra², Carmine Pizzi³, Marco Merlo⁴, Filippo Zilio⁵, Francesco Bianco⁶, Massimo Mancone⁷, Denise Zaffalon⁴, Rocco Gioscia⁸, Luca Bergamaschi³, Paolo Compagnucci², Matteo Armillotta³, Michela Casella², Angelo Sansonetti³, Marco Marini⁹, Pasquale Paolisso¹⁰, Giulia Stronati², Sabina Gallina¹¹, Antonio Dello Russo², Gian Piero Perna⁹, Francesco Fedele⁷, Roberto Bonmassari⁵, Giuseppe De Luca¹², Isabella Tritto¹³, Tommaso Piva⁹, Gianfranco Sinagra⁴, Giuseppe Ambrosio¹³, Juan Carlos Kaski¹⁴, Monica Verdoia⁸

Affiliations

¹ Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy. Electronic address: giuseppe.ciliberti@ospedaliriuniti.marche.it.
² Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
³ Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna; Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy.
⁴ Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Italy.
⁵ Department of Cardiology, S. Chiara Hospital, Trento, Italy.
⁶ Department of Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero-Universitaria "Ospedali Riuniti", Ancona, Italy.
⁷ Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Rome, Italy.
⁸ Ospedale degli Infermi, Biella, Italy.
⁹ Cardiology and Coronary Care Unit, Marche University Hospital, Ancona, Italy.
¹⁰ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Dept. of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
¹¹ Department of Neuroscience, Imaging and clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
¹² Division of Cardiology, Policlinico AOU G. Martino, and Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy.
¹³ Division of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
¹⁴ Molecular and Clinical Sciences, St George's, University of London, London, UK.

PMID: 37852517
DOI: 10.1016/j.pcad.2023.10.006

Abstract

Background: Myocardial infarction (MI) with non-obstructed coronary arteries (MINOCA) is an increasingly recognized condition with challenging management. Some MINOCA patients ultimately experience recurrent acute MI (re-AMI) during follow-up; however, clinical and angiographic factors predisposing to re-AMI are still poorly defined.

Methods: In this retrospective multicenter cohort study we enrolled consecutive patients fulfilling diagnostic criteria of MINOCA according to the IV universal definition of myocardial infarction; characteristics of patients experiencing re-AMI during the follow-up were compared to a group of MINOCA patients without re-AMI.

Results: 54 patients (mean age 66 ± 13) experienced a subsequent re-AMI after MINOCA and follow-up was available in 44 (81%). Compared to MINOCA patients without re-AMI (n = 695), on first invasive coronary angiography (ICA) MINOCA patients with re-AMI showed less frequent angiographically normal coronaries (37 versus 53%, p = 0.032) and had a higher prevalence of atherosclerosis involving 3 vessels or left main stem (17% versus 8%, p = 0.049). Twenty-four patients (44%) with re-AMI underwent a new ICA: 25% had normal coronary arteries, 12.5% had mild luminal irregularities (<30%), 20.8% had moderate coronary atherosclerosis (30-49%), and 41.7% showed obstructive coronary atherosclerosis (≥50% stenosis). Among patients undergoing new ICA, atherosclerosis progression was observed in 11 (45.8%), 37.5% received revascularization, only 4.5% had low-density lipoprotein cholesterol (LDL_C) under 55 mg/dL and 33% experienced a new cardiovascular disease (CVD) event (death, AMI, heart failure, stroke) at subsequent follow-up.

Conclusions: In the present study, only a minority of MINOCA patients with re-AMI underwent a repeated ICA, nearly one out of two showed atherosclerosis progression, often requiring revascularization. Recommended LDL-C levels were achieved only in a minority of the cases, indicating a possible underestimation of CVD risk in this population.

Keywords: Acute myocardial infarction; Coronary angiography; MINOCA; Outcomes.

Publication types

Multicenter Study

MeSH terms

Aged
Atherosclerosis*
Cohort Studies
Coronary Angiography
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / epidemiology
Coronary Artery Disease* / therapy
Coronary Vessels
Humans
MINOCA
Middle Aged
Myocardial Infarction* / diagnosis
Myocardial Infarction* / epidemiology
Myocardial Infarction* / therapy
Risk Factors