One-year prognosis difference of MINOCA versus MI-CAD in developing countries: insights from the Moroccan experience

Abstract

Abstract Introduction The debate remains open as to the difference in prevalence of mortality and occurrence of acute events in patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA) and others with Myocardial infarction with coronary arteries disease (MI-CAD) (1). Purpose We carried out an analysis of the clinical characteristics and one-year prognosis of MINOCA versus MI-CAD. Methods We conducted a prospective study for patients admitted for Acute coronary syndrome (ACS) during 2-years, to analyze the clinical and prognostic characteristics of patients with MINOCA versus MI-CAD. We defined 1-year all-cause mortality as the primary outcome, and the secondary outcome as a composite of 1-year readmission for myocardial infarction or acute heart failure (AHF). The primary and secondary outcomes was studied using a Cox proportional hazards regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for variables described in the literature. Results Our study included 1077 patients, 95.3% with MI-CAD and 4.7% with MINOCA. At admission, 71.1% patient were diagnosed STEMI and 28.9% with NSTEMI. The difference between the two groups was found on age (p<0.001), hypertension, diabetes with consecutive p-values of 0.007 and 0.001, as well as Ejection fraction (p<0.001). For the outcomes studied, we found, firstly before adjustment, that patients in the MINOCA group had a better prognosis than the MI-CAD group, for all-cause 1-year mortality (HR=0. 442; 95%CI 0.227-0.760; p=0.041) with a significant difference in the Kaplein Meier survival analysis with a log-rank test (p-value =0.02) (Figure 1), and a lower risk of readmission for ACS (HR=0.297; 95%CI 0.316-0.821; p=0.034), as well as for readmission for AHF (HR=0.555; 95%CI 0.329-0.836; p=0.045) also with a significant difference between the two groups in the Kaplein Meier analysis with consecutive log-rank test p-values of 0.033 and 0.035 (Figure 2). After adjustment for age, arterial hypertension, diabetes, active smoking, EF<40%, proximal LAD or LM as culprit artery, TIMI 0-I flow, CRP >300mg and cardiogenic shock during hospitalization, the results remained significantly in favor of a better prognosis for MINOCA: (HR=0. 672; 95%CI 0.376-0.872; p=0.003) for 1-year all-cause mortality, (HR=0.301; 95%CI 0.482-0.879; p=0.012) for readmission for ACS and finally (HR=0.604; 95%CI 0.309-0.812; p=0.039) for readmission for AHF. Conclusion Despite the ambiguity in the genesis of MINOCA, the short- and long-term prognosis of these patients remains generally favorable.Figure 1.Figure 2.