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Comparing pharmacotherapy in MINOCA versus medically managed obstructive acute coronary syndrome

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Abstract

Most prior studies have compared myocardial infarction with non-obstructive coronary arteries (MINOCA), to obstructive acute coronary syndrome (ACS) often requiring revascularisation. However, these were subject to treatment bias given the significant differences in management. This study uniquely compares the management and outcomes of MINOCA patients with a medically managed obstructive ACS (M-ACS) population. We retrospectively analysed registry data for consecutive patients admitted to the Gold Coast University Hospital with ACS requiring coronary angiography and identified patients with MINOCA and M-ACS. Baseline characteristics, pharmacological therapy and in-hospital outcomes were compared. In hospital outcomes were composite NACE, heart failure, stroke and major bleeding. Multivariate regression analysis was also performed to identify independent predictors of MINOCA. Multivariate regression analysis was also performed to identify independent predictors of MINOCA. We identified 139 patients with MINOCA and 142 patients with medically managed obstructive ACS (M-ACS). Multivariate regression analysis also identified female sex and cancer as independent predictors of MINOCA with odds ratios of 5.57 and 3.01, respectively. MINOCA patients were significantly less likely to receive cardioprotective medications at admission and discharge, specifically aspirin, beta-blockers, ACE-I and statins, compared to those with M-ACS. While mortality was higher among M-ACS patients (0.0% vs. 3.6%; p = 0.03), no significant differences were noted for composite NACE, heart failure, stroke and major bleeding. MINOCA patients have similar outcomes to M-ACS. Despite this, we noted a discrepancy in the use of cardioprotective medications. We also identified female sex and cancer were independent predictors of MINOCA. This may represent a missed opportunity to prevent adverse events among patients with MINOCA. Large, randomised trials are required to provide more definitive evidence.

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Fig. 1
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Abbreviations

ACE-I:

Angiotensin converting enzyme inhibitors

ACS:

Acute coronary syndrome

ARB:

Angiotensin receptor blockers

CAD:

Coronary artery disease

M-ACS:

Medically managed acute coronary syndrome

MACE:

Major adverse cardiac events

MI:

Myocardial infarction

MINOCA:

Myocardial infarction with non-obstructive coronary arteries

NACE:

Net adverse cardiac events

PAD:

Peripheral artery disease

STEMI:

ST elevation myocardial infarction

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, 4029, Australia

    Cobi Adams

  2. Faculty of Medicine, University of Queensland, Brisbane, QLD, 4029, Australia

    Cobi Adams

  3. The Madison Practice, 169 Mona Vale Road, St Ives, NSW, 2075, Australia

    Gagandeep Sawhney

  4. Department of Cardiology, Gold Coast University Hospital, Gold Coast, QLD, 4215, Australia

    Kuljit Singh

  5. Department of Medicine, Gold Coast University Hospital, Griffith University, 1 Hospital Blvd, Southport, QLD, 4215, Australia

    Kuljit Singh

Authors
  1. Cobi Adams
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  2. Gagandeep Sawhney
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  3. Kuljit Singh
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Correspondence to Kuljit Singh.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Gold Coast Hospital and Health Service Human Research Ethics Committee (HREC) and, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments (Reference number-HREC/17/QGC/174).

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Adams, C., Sawhney, G. & Singh, K. Comparing pharmacotherapy in MINOCA versus medically managed obstructive acute coronary syndrome. Heart Vessels 37, 705–710 (2022). https://doi.org/10.1007/s00380-021-01956-2

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