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3 Prognostic risk stratification tool (CMR and conventional risk factors) in myocardial infarction with non-obstructed coronary arteries (MINOCA)
  1. Amardeep Ghosh Dastidar,
  2. Estefania De Garate,
  3. Jonathan Rodrigues,
  4. Anna Baritussio,
  5. Zsofiya Drobni,
  6. Priyanka Singhal,
  7. Giovanni Biglino,
  8. Gianni Angelini,
  9. Stephen Dorman,
  10. Julian Strange,
  11. Andreas Baumbach,
  12. Tom Johnson,
  13. Chiara Bucciarelli-Ducci
  1. NIHR Bristol Cardiovascular Biomedical Research Unit, Bristol Heart Institute, UK

Abstract

Introduction Evidence on the prognostic role of Cardiac ?Magnetic Resonance (CMR) and conventional risk factors in myocardial infarction with non-obstructed coronaries (MINOCA) is lacking. Aim: To assess the prognostic impact of CMR and conventional risk factors in MINOCA.

Methods 402 consecutive MINOCA patients undergoing CMR scan were prospectively followed up for primary clinical endpoint of all-cause mortality. 1.5T CMR was performed using a comprehensive protocol. Patients were grouped into 4 categories based on CMR findings: MI (embolic/spontaneous recanalisation), myocarditis, cardiomyopathy and normal CMR.

Results Overall, CMR was able to identify the cause for the troponin rise in 74% (26% MI, 24% myocarditis and 23% cardiomyopathy). In a mean follow up of 2.5years, 4.5% patients died. Cardiomyopathy group had the worst prognosis (mortality – 12%, log rank 15.97 p=0.001). MI and normal both had 3% mortality and myocarditis 1%. In a multivariate model that included clinical and CMR parameters, CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation ECG remained the only 2 significant predictors of mortality. Using a risk score with 1 point each for presentation as STEMI and CMR diagnosis of cardiomyopathy, the mortality risk rates for a score of 0, 1 and 2 were 2%, 7% and 21% respectively (p<0.0001).

Conclusion A CMR diagnosis was identified in 74% of MINOCA. Cardiomyopathy has the highest mortality, followed by MI and myocarditis. The strongest predictors of mortality were a CMR diagnosis of cardiomyopathy and ST-elevation on presentation ECG, thereby allowing a robust stratification of patients.

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