Arq Bras Cardiol: Imagem cardiovasc 2020; 33(4): 1-7
Value of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Patients with Acute Myocardial Infarction with Nonobstructive Coronary Artery Disease (MINOCA)
DOI: 10.47593/2675-312X/20203304eabc97
Abstract
Background
Myocardial infarction is one of the major causes of morbidity and mortality worldwide and 13.2% of patients with acute coronary syndrome have normal or unobstructed coronary arteries, called MINOCA (Myocardial Infarction with Non-Obstructive Coronary Artery). Cardiac magnetic resonance (CMR) is the gold standard for investigating the etiology of acute coronary syndrome. Although MINOCA has a more benign evolution than myocardial infarction due to coronary obstruction, its prognostic factors are not completely elucidated.
Objective
To evaluate prognosis, predictive factors and describe the incidence of major adverse cardiovascular events in patients with MINOCA.
Methods
Prospective cohort through data collection of patients admitted to the emergency department of a tertiary hospital, diagnosed with MINOCA from 2012 to 2019. The mean follow-up was 45 months, the outcomes considered were: death, rehospitalization due to cardiac causes, recurrence of chest pain, myocardial revascularization (MACE).
Results
Of the 179 patients, 52% were male, with a mean standard deviation age of 57.3 ± 15.5 years. A MACE rate of 17.9% was observed during a mean follow-up of 45 ± 21 months. Mortality at the end of follow-up was 3.8%. In the multivariate analysis using the Cox regression model, patients with normal CMR was shown to be a predictor of good prognosis (HR 0.09; 95% CI 0.01 – 0.88; p = 0.04). The Kaplan-Meier curve showed a significant difference (Log Rank x2 = 9.83 p = 0.02) in the prediction of free MACE.
Conclusion
Normal CMR was an independent predictor of good prognosis in this sample and could be useful in the risk stratification of patients with MINOCA.
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