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Impact of inflammatory conditions in myocardial infarction with non-obstructive coronary arteries.

Session Myocardial infarction and non-obstructive coronary artery disease: MINOCA in men and women

Speaker Maria Jesus Espinosa Pascual

Event : ESC Congress 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Inflammation
  • Session type : Advances in Science

Authors : MJ Espinosa Pascual (Getafe,ES), J Lopez Pais (Getafe,ES), B Izquierdo Coronel (Getafe,ES), D Galan Gil (Getafe,ES), J Gorriz Magana (Getafe,ES), P Awamleh Garcia (Getafe,ES), CG Martinez Peredo (Getafe,ES), R Mata Caballero (Getafe,ES), A Fraile Sanz (Getafe,ES), JJ Alonso Martin (Getafe,ES)

M.J. Espinosa Pascual1 , J. Lopez Pais1 , B. Izquierdo Coronel1 , D. Galan Gil1 , J. Gorriz Magana1 , P. Awamleh Garcia1 , C.G. Martinez Peredo1 , R. Mata Caballero1 , A. Fraile Sanz1 , J.J. Alonso Martin1 , 1University Hospital of Getafe, Cardiology - Getafe - Spain ,

European Heart Journal ( 2018 ) 39 ( Supplement ), 677

Background: Chronic inflammation causes and accelerates many diseases. Although the myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) has seen a large increase of attention in the cardiology field, several aspects of this syndrome still remain unknown. The objective of this study is to analyze the relationship between proinflammatory conditions and MINOCA, as well as the impact on their prognosis.

Methods: Analytical and observational study developed in a University Hospital that included 118 MINOCA patients (pts) admitted to our center in the last 3 years (2015–2017) and compared them with 269 consecutive pts diagnosed of MI related to obstructive coronary disease during a 18 month period (July 1st, 2016 to December 31st, 2017). We used the definitions and management of 2016 ESC Working Group Position Paper on MINOCA. We recorded information about pro-inflammatory conditions (allergies, autoimmune pathologies like vasculitis, connective tissue diseases, cancer and C-reactive protein (C-RP) levels). We also examined if the MI was an intercurrent complication during admission for a non-cardiovascular pathology (non-CV). Follow up analysis included death from any cause, readmissions, angina, dyspnea, functional class worse than II and major adverse cardiac events (MACE; a composite of cardiac death, myocardial infarction, and stroke). Our median follow up was 17 months.

Results: The composite of pro-inflammatory conditions (allergies, autoimmune pathologies, connective tissue disease and cancer) was significantly higher in the MINOCA group (38% vs 17%, p<0.001). Patients with MINOCA had higher rates of cancer (10% vs 4%, p 0.016), autoimmune diseases (19% vs 10%, p 0.014), allergies (20% vs 7%, p<0.001) and connective tissue disorders (8% vs 1.5%, p 0.004). C-RP levels tended to be higher in MINOCA pts (31mg/L vs 21mg/L, p 0.127). In the follow-up the composite of pro-inflammatory conditions was related to a significantly higher mortality from any cause (15% vs 0%, p 0.004), readmissions (71% vs 33%, p 0.011), angina (11% vs 0%, p 0.011), dyspnea (22% vs 5% p 0.016) and a functional class worse than II (24% vs 5% p 0.007). MACE also tended to be more frequent in these pts (13% vs 6% p 0.218). The number of deaths was greater in MINOCA pts with either active cancer (36% vs 2.4%, p<0.001) or vasculitis (50% vs 5.4%, p 0.01). If developing a MINOCA was an intercurrent complication during admission for a non-cardiovascular pathology, the chances of death or readmission were higher (25 vs 4.6, p 0.023 and 71.4 vs 33.7, p 0.004 respectively).

Conclusion: This study suggests that pro-inflammatory disorders may be a risk factor for developing MINOCA and having a worse prognosis (mortality, readmissions and functional class). Further research is needed to confirm this finding and identify its optimal management.

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