Results of dynamic follow-up for patients with myocardial infarction without obstructive lesion of coronary arteries: data of the overall register for acute coronary syndrome in Krasnodar region

Background. Myocardial infarction (MI) without obstructive lesion of coronary arteries (MINOCA) has incidence  to 14%. Despite its high prevalence,  MINOCA is paid not enough attention, therefore some patients can not receive appropriate treatment.

Aim. Evaluating the long-term results of clinical observation in patients with MINOCA  in comparison with patients with obstructive damage and the subsequent revascularization of myocardium.

Material and methods. On the basis of Scientific Research Institute RCH – 1 the multicenter cohort observation was organized. Patients from the register CROCS (the register of acute coronary syndrome in Krasnodar region) with the  diagnosis MI were divided into two groups: MINOCA including patients without obstructive damage of coronary arteries and MINOCA including patients with obstructive injury and the subsequent stenting a heart attack connected artery. All patients in 12 months would have control assessment during which they had objective survey; electrocardiography; daily monitoring; test of six-minute walking, echocardiography.

Results. In the MINOCA group in 12 months after the acute coronary event in 21.5% cases there were tension stenocardia, in 16.2% – a painless form of myocardial ischemia was revealed, in a group of patients with MINOCA stenocardia of tension was revealed at 12.5% and 8.4% – with painless ischemia. The group of patients with MINOCA is characterized  by more reliable decrease in both parameters of heart rate variability, and turbulence of heart rate. MINOCA is followed by statistically significant increase in risk of ACS development and death within 12 months. All indicators had reliable difference.

Conclusion. Patients with MINOCA are a special group, their differential characteristics demand definite diagnostic efforts.

1. Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL, De Caterina R, Zimarino M, Roffi M, Kjeldsen K, Atar D, Kaski JC, Sechtem U, Tornvall P; Working Group on Cardiovascular Pharmacotherapy. ESC Working Group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38:143-53.

2. Raparelli V, Elharram M, Shimony A, Eisenberg MJ, Cheema AN, Pilote L. Myocardial Infarction With No Obstructive Coronary Artery Disease: Angiographic and Clinical Insights in Patients With Premature Presentation. Can J Cardiol. 2018;34:468-476.

3. Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjöld AM, Gard A, Jernberg T. Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease. Circulation. 2017;135:1481-9.

4. Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861-870.

5. Twerenbold R, Wildi K, Jaeger C, Gimenez MR, Reiter M, Reichlin T, Walukiewicz A, Gugala M, Krivoshei L, Marti N, Moreno Weidmann Z, Hillinger P, Puelacher C, Rentsch K, Honegger U, Schumacher C, Zurbriggen F, Freese M, Stelzig C, Campodarve I, Bassetti S, Osswald S, Mueller C. Optimal cutoff levels of more sensitive cardiac troponin assays for the early diagnosis of myocardial infarction in patients with renal dysfunction. Circulation. 2015;131:2041-50.

6. Abdelghany M, Subedi R, Shah S, Kozman H. Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. Int J Cardiol. 2017;232:1-4.

7. Klimov AN, Parfenova NS, Golikov YuP. To the 100th anniversary of the creation of a cholesteric model of atherosclerosis. Biomedical Chemistry. 2012;58(1):5-11. (In Russ.).

8. Erlih AD, Gracianskij NA. Rezul’taty shestimesyachnogo nablyudeniya za bol’nymi s ostrymi koronarnymi sindromami v Rossijskom registre REKORD. Kardiologiya. 2011;12:18-23. (In Russ.).

9. Marzilli M, Merz CNB., Boden WE, Bonow RO, Capozza PG, Chilian WM, DeMaria AN, Guarini G, Huqi A, Morrone D, Patel MR, Weintraub WS. Obstructive coronary atherosclerosis and ischemic heart disease: an elusive connection. Rational Pharmacotherapy in Cardiology. 2012;8(5):721-726.