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The Portuguese perspective on the management of MINOCA patients
Session:
SESSÃO DE POSTERS 33 - DOENÇAS CARDIOVASCULARES - MINOCA E SÍNDROME DE TAKOTSUBO
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida G. Figueiredo; Sofia B. Paula; Mariana Santos; Hélder Santos; Samuel Almeida; Lurdes Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: In January 2017, the European Society of Cardiology (ESC) published a position paper introducing the diagnostic criteria for MINOCA (Myocardial infarction with non-obstructive coronary artery disease). The prevalence of MINOCA varies between 1-14% and can have different causes. Currently, there is still great variability in the management of this entity. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: T</strong>o compare the differences between patients (P) hospitalised in Portugal with a diagnosis of MINOCA before and after the publication of the ESC position paper, regarding the management of these P, namely in terms of pharmacological treatment. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Multicentre retrospective study, based on the Portuguese Registry of ACS, from 1/10/2010 to 7/05/2024. Only P hospitalized with a diagnosis of MINOCA (coronary stenosis <50%) were included. P were then divided into two groups: A – before 2017 – and B – from 2017. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>Group A had 1905 P (39%) while group B had 3004 P (61%). 58% of P were male in group A vs 71% in group B (p<0.001), mean age was 65.8±12.8 vs 66.3±12.7 years, and the majority of patients were 45 to 55 years old in both groups (39.4% vs 39.9%, p=0.760). 24% of P in group A had diabetes mellitus comparing to 28% of P in group B (p=0.013), 63% of P had dyslipidaemia vs 58% (p<0.001), and 21% of P were smokers vs 24% (p=0.006). The most common clinical presentation was chest pain (94% in both groups); 45% of P in group A and 28% in group B had a normal ECG (p<0.001), with the main alterations in ECG being T wave inversion (18% vs 10%, p<0.001). Elevation of cardiac troponins was presented in 15% of P in group A vs 25% of P in group B (p<0.001) and 78% of P had preserved ejection fraction (LVEF ≥50%) vs 68% in group B (p<0.001). All P of both groups performed coronary angiography, 4% of P in group A performed >1 coronary angiography vs 18% in group B (p<0.001). Pharmacological treatment of both groups before hospitalisation, during hospitalisation and at discharge is described in tables 1A, 1B and 1C, respectively. There was no information in the Registry of ACS regarding cardiac magnetic resonance imaging (MRI) or invasive coronary function testing. In which concerns complications during hospitalisation, P in group A developed more heart failure (8% vs 4%, p<0.001) while intrahospital mortality was higher in P in group B (2.0% vs 0.8%, p<0.001). </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>MINOCA is a term that encompasses a heterogeneous group of underlying causes, making it crucial<strong> </strong>to perform further assessments and investigations to establish the underlying cause of the MINOCA, which allows appropriate management of P, since failure to identify the underlying cause of MINOCA may result in<strong> </strong>inadequate therapy. In our study, a significant number of P in group B was discharged under dual antiplatelet therapy. Functional coronary assessment and cardiac MRI would have been important tools to make a decision regarding pharmacological therapy of these patients. </span></span></p>
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