Is an ischemic origin in MINOCA patients predictable?
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ORIGINAL PAPER
Is an ischemic origin in MINOCA patients predictable? Alban Lamour1,2 · Audrey Camarzana1,2 · Christoph Gräni3 · Céleste Le Roux1,2 · Serge Willoteaux1,4 · Fabrice Prunier1,2 · Alain Furber1,2 · Loïc Bière1,2 Received: 16 April 2020 / Accepted: 13 July 2020 © Springer Nature B.V. 2020
Abstract This study sought to identify parameters that could guide towards an ischemic origin in patients hospitalized for myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). MINOCA is challenging in clinical practice, as the pathophysiology is multifaceted. A total of 135 patients with MINOCA who underwent cardiovascular magnetic resonance imaging (CMR) in a single tertiary University Hospital, were retrospectively included. The study cohort was classified into 4 groups according to the CMR diagnosis (i.e., myocarditis, myocardial infarction, Takotsubo cardiomyopathy, normal or uncommon diagnosis). According to the CMR, 62% had myocarditis, 14.1% myocardial infarction, 4.4% of Takotsubo and 19.3% showed a normal CMR or uncommon diagnoses. In the multivariate analysis, three criteria were independently correlated with the underlying diagnosis of myocardial infarction: (1) the absence of inflammatory response (HR: 5.71 IC95% [1.79–18.28]; p = 0.002), (2) the presence of coronary atheroma in invasive coronary angiography (HR: 6.56 IC95% [2.27–18.92]; p = 0.001) and (3) a peak of troponin ratio elevated than normal levels of 150 (HR: 4.12 IC95% [1.45–11.65]; p = 0.01). The prevalence of myocardial infarction in MINOCA was 4.9% in the absence of these three criteria, 3.4% with one of the criteria present, 34.5% with two criteria present and 71.4% with all three criteria. The negative predictive value for MI was 96% in the presence of at least two criteria. Our study shows that the absence of inflammatory response, a high troponin and the presence of angiographic coronary atheroma are independently correlated with a myocardial infarction underlying cause of MINOCA. Keywords MINOCA · CMR · Myocarditis
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is encountered in about 5 to 10% of patients presenting with symptoms of acute coronary syndrome [1]. Its pathophysiology is multifaceted and diagnosis and therapy vary depending of the underlying cause. One of the key steps is to discriminate an MI event from an inflammatory cause * Loïc Bière lobiere@chu‑angers.fr 1
Institut Mitovasc, UMR CNRS 6015-INSERMU1083, University of Angers, 49000 Angers, France
2
Department of Cardiology, University Hospital of Angers, 49000 Angers, France
3
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4
Department of Radiology, University Hospital of Angers, 49000 Angers, France
like myocarditis, making MINOCA a working diagnosis [1]. In MINOCA with suspected MI event, further invasive management may be warranted, including provocative spasm testing, or intravascular optical coherence tomography to assess a plaque disru
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