Prognostic Implications of Coronary Artery Sclerosis in Troponin-Positive Patients with Non-Obstructive Coronary Arteries.
Atherosclerosis
Coronary artery disease
Myocardial infarction with non-obstructive coronary arteries (MINOCA)
Journal
Cardiology and therapy
ISSN: 2193-8261
Titre abrégé: Cardiol Ther
Pays: England
ID NLM: 101634495
Informations de publication
Date de publication:
04 Jul 2024
04 Jul 2024
Historique:
received:
09
04
2024
accepted:
19
06
2024
medline:
4
7
2024
pubmed:
4
7
2024
entrez:
4
7
2024
Statut:
aheadofprint
Résumé
Coronary sclerosis is a risk factor for the progression to obstructive coronary artery disease (CAD). However, understanding its impact on the outcomes of patients with myocardial infarction and non-obstructive coronary arteries is limited. This study aimed to explore the prognostic influence of coronary sclerosis on in- and out-of-hospital events in troponin-positive patients with non-obstructive coronary arteries. This study was a retrospective cohort analysis based on prospectively collected data. A total of 24,775 patients who underwent coronary angiography from 2010 to 2021 in a German university hospital were screened, resulting in a final study cohort of 373 troponin-positive patients with non-obstructive coronary arteries and a follow-up period of 6.2 ± 3.1 years. Coronary sclerosis was defined as coronary plaques without angiographically detectable stenotic lesions of 50% or more in the large epicardial coronary arteries. The primary study endpoint was the occurrence of in-hospital events. Secondary endpoints included events during follow-up. Patients with coronary sclerosis were significantly older (70 ± 12 vs. 58 ± 16 years, p < 0.001), had ST-segment elevation less frequently on electrocardiogram (9.4% vs. 18.7%, p = 0.013), and suffered more often from diabetes mellitus (23.3% vs. 13.1%, p = 0.009), arterial hypertension (79.6% vs. 59.8%, p < 0.001), chronic obstructive pulmonary disease (17.1% vs. 9.4%, p = 0.028), chronic kidney disease (22.2% vs. 8.4%, p < 0.001), atrial fibrillation (19.8% vs. 12.2%, p = 0.045), and valvular diseases than patients without CAD. Patients with coronary sclerosis were more likely to receive medication for primary/secondary prevention on admission and at discharge. The incidence of in- and out-of-hospital events was significantly higher in patients with coronary sclerosis (in-hospital: 42.8% vs. 29.9%, p = 0.010; out-of-hospital: 46.0% vs. 26.1%, p < 0.001). Mortality rates tended to be higher in the coronary sclerosis group (29.4% vs. 20.0%, p = 0.066). Patients diagnosed with coronary sclerosis presented a higher incidence of comorbidities and increased medication use, and experienced higher rates of both in-hospital and out-of-hospital events, primarily due to the clustering of cardiovascular risk factors.
Identifiants
pubmed: 38963510
doi: 10.1007/s40119-024-00375-4
pii: 10.1007/s40119-024-00375-4
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2024. The Author(s).
Références
Byrne RA, et al. ESC guidelines for the management of acute coronary syndromes. Eur Heart J. 2023. https://doi.org/10.1093/eurheartj/ehad191 .
doi: 10.1093/eurheartj/ehad191
pubmed: 37632756
Thygesen K, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018;138:e618–51. https://doi.org/10.1161/cir.0000000000000617 .
doi: 10.1161/cir.0000000000000617
pubmed: 30571511
Collet J-P, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020;42:1289–367. https://doi.org/10.1093/eurheartj/ehaa575 .
doi: 10.1093/eurheartj/ehaa575
Ishii M, et al. Characteristics and in-hospital mortality of patients with myocardial infarction in the absence of obstructive coronary artery disease in super-aging society. Int J Cardiol. 2020;301:108–13. https://doi.org/10.1016/j.ijcard.2019.09.037 .
doi: 10.1016/j.ijcard.2019.09.037
pubmed: 31740139
Kallmeyer A, et al. Absence of high lipoprotein(a) Levels is an independent predictor of acute myocardial infarction without coronary lesions. J Clin Med. 2023;12:960. https://doi.org/10.3390/jcm12030960 .
doi: 10.3390/jcm12030960
pubmed: 36769608
pmcid: 9917543
Lopez-Pais J, et al. Clinical characteristics and prognosis of myocardial infarction with non-obstructive coronary arteries: a prospective single-center study. Cardiol J. 2022;29:798–806. https://doi.org/10.5603/CJ.a2020.0146 .
doi: 10.5603/CJ.a2020.0146
pubmed: 33140385
pmcid: 9550329
Barr PR, et al. Myocardial infarction without obstructive coronary artery disease is not a benign condition (ANZACS-QI 10). Heart, Lung & Circ. 2018;27:165–74. https://doi.org/10.1016/j.hlc.2017.02.023 .
doi: 10.1016/j.hlc.2017.02.023
Pizzi C, et al. Nonobstructive versus obstructive coronary artery disease in acute coronary syndrome: a meta-analysis. J Am Heart Assoc. 2016. https://doi.org/10.1161/JAHA.116.004185 .
doi: 10.1161/JAHA.116.004185
pubmed: 27986756
pmcid: 5210396
Rakowski T, et al. Characteristics of patients presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA) in Poland: data from the ORPKI national registry. J Thromb Thrombolysis. 2019;47:462–6. https://doi.org/10.1007/s11239-018-1794-z .
doi: 10.1007/s11239-018-1794-z
pubmed: 30565147
Safdar B, et al. Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study. J Am Heart Assoc Cerebrovasc Dis. 2018. https://doi.org/10.1161/JAHA.118.009174 .
doi: 10.1161/JAHA.118.009174
Kong M, Liu F, Zhu Z. Analysis between high risk of myocardial infarction with non-obstructive coronary artery disease in single center and occurrence of major adverse cardiovascular events. Ann Noninvasive Electrocardiol. 2022;27:e13007.
doi: 10.1111/anec.13007
pubmed: 36217554
pmcid: 9674789
Arnold SV, et al. Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association. Circulation. 2020;141:e779–806. https://doi.org/10.1161/CIR.0000000000000766 .
doi: 10.1161/CIR.0000000000000766
pubmed: 32279539
Raitakari O, Pahkala K, Magnussen CG. Prevention of atherosclerosis from childhood. Nat Rev Cardiol. 2022;19:543–54. https://doi.org/10.1038/s41569-021-00647-9 .
doi: 10.1038/s41569-021-00647-9
pubmed: 34987194
Charoensri S, Kritmetapak K, Tangpattanasiri T, Pongchaiyakul C. The impact of new-onset diabetes mellitus and hypertension on all-cause mortality in an apparently healthy population a ten-year follow-up study. J Diabet Res. 2021;2021:3964013. https://doi.org/10.1155/2021/3964013 .
doi: 10.1155/2021/3964013
Batra G, et al. Interleukin 6 and cardiovascular outcomes in patients with chronic kidney disease and chronic coronary syndrome. JAMA Cardiol. 2021;6:1440–5. https://doi.org/10.1001/jamacardio.2021.3079 .
doi: 10.1001/jamacardio.2021.3079
pubmed: 34431970
Ruilope LM, et al. Blood pressure and cardiorenal outcomes with finerenone in chronic kidney disease in type 2 diabetes. Hypertension. 2022;79:2685–95. https://doi.org/10.1161/HYPERTENSIONAHA.122.19744 .
doi: 10.1161/HYPERTENSIONAHA.122.19744
pubmed: 36252131
Li Y, et al. The impact of chronic obstructive pulmonary disease on the prognosis outcomes of patients with percutaneous coronary intervention or coronary artery bypass grafting: a meta-analysis. Heart lung: J Crit Care. 2023;60:8–14. https://doi.org/10.1016/j.hrtlng.2023.02.017 .
doi: 10.1016/j.hrtlng.2023.02.017
Lowenstern A, et al. Age-related differences in the noninvasive evaluation for possible coronary artery disease: insights from the prospective multicenter imaging study for evaluation of chest pain (PROMISE) trial. JAMA Cardiol. 2020;5:193–201. https://doi.org/10.1001/jamacardio.2019.4973 .
doi: 10.1001/jamacardio.2019.4973
pubmed: 31738382
Radico F, et al. Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis. Eur Heart J. 2018;39:2135–46. https://doi.org/10.1093/eurheartj/ehy185 .
doi: 10.1093/eurheartj/ehy185
pubmed: 29688324
Kristensen KE, et al. Subclinical atherosclerosis is associated with incident atrial fibrillation: a systematic review and meta-analysis. Eur : Eur Pacing, Arrhythm, Cardiac Electrophysiol. 2020;22:991–1000. https://doi.org/10.1093/europace/euaa030 .
doi: 10.1093/europace/euaa030
Taha A, et al. New-onset atrial fibrillation after coronary artery bypass grafting and long-term outcome: a population-based nationwide study from the SWEDEHEART registry. J Am Heart Assoc. 2021;10:e017966.
doi: 10.1161/JAHA.120.017966
pubmed: 33251914
Joglar JA, et al. ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149:e1–156. https://doi.org/10.1161/CIR.0000000000001193 .
doi: 10.1161/CIR.0000000000001193
pubmed: 38033089
Frederiksen TC, et al. The bidirectional association between atrial fibrillation and myocardial infarction. Nat rev Cardiol. 2023;20:631–44. https://doi.org/10.1038/s41569-023-00857-3 .
doi: 10.1038/s41569-023-00857-3
pubmed: 37069297
Emren ZY, et al. Evaluation of the prevalence of coronary artery disease in patients with valvular heart disease. J Cardiothorac Surg. 2014;9:153. https://doi.org/10.1186/s13019-014-0153-1 .
doi: 10.1186/s13019-014-0153-1
pubmed: 25179559
pmcid: 4176870
Lindahl B, et al. Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease. Circulation. 2017;135:1481–9. https://doi.org/10.1161/circulationaha.116.026336 .
doi: 10.1161/circulationaha.116.026336
pubmed: 28179398
Dal Fabbro J, et al. Clinical and electrocardiographic features of patients with myocardial infarction with non-obstructive coronary artery disease (MINOCA). J Cardiovasc Med. 2021;22:104–9. https://doi.org/10.2459/JCM.0000000000001027 .
doi: 10.2459/JCM.0000000000001027
Sinha A, et al. Rethinking false positive exercise electrocardiographic stress tests by assessing coronary microvascular function. J Am Coll Cardiol. 2024;83:291–9. https://doi.org/10.1016/j.jacc.2023.10.034 .
doi: 10.1016/j.jacc.2023.10.034
pubmed: 38199706
pmcid: 10790243
Bogossian H, Alhanafi D, Kloppe A, Höltgen R, Mijic D. Stress testing: a relevant examination in rhythmology. Herzschr Elektrophysiol. 2023;34:333–8. https://doi.org/10.1007/s00399-023-00967-y .
doi: 10.1007/s00399-023-00967-y