CHARACTERISTICS AND OUTCOME OF PATIENTS WITH VARIOUS TYPE OF ACUTE CORONARY SYNDROME

• Published in: European heart journal supplements Vol. 26; no. Supplement_2; pp. ii22 - ii23
• Main Authors: Aleksova, A, Fluca, A, Munaretto, L, Chiaradia, V, Barbati, G, Derin, A, D‘Errico, S, Di Lenarda, A, Hiche, C, Sinagra, G, Janjusevic, M
• Format: Journal Article
• Language: English
• Published: 16.05.2024
• ISSN: 1520-765X; 1554-2815
• DOI: 10.1093/eurheartjsupp/suae036.047

Abstract Background and Aim Acute coronary syndrome with non–critical coronary arteries comprises distinct entities with unique pathophysiological, diagnostic, therapeutic and prognostic characteristics. The aim was to compare the clinical and prognostic features of cohorts presenting NSTEMI and non–critical coronary arteries disease, i.e. MINOCA, type 2 myocardial infarction (MI), Takotsubo syndrome (TTS), with a cohort of classical type 1 MI with critical coronary arteries disease. Methods In this single–center observational retrospective study, 18223 patients who underwent invasive coronary angiography between 2005 and 2022 were screened. Overall, 1162 patients were included (301 MINOCA, 237 type 2 MI, 138 TTS, and 486 with type 1 MI). The primary endpoint was a composite of non–fatal acute MI, non–fatal TIA or stroke, hospitalization for HF (hHF), and death. Secondary endpoints were (1) hHF, (2) a composite event of atrial fibrillation (AF), TIA, and/or stroke, and (3) all–cause mortality. Results The average age was 68.2 years, with 47% being male. At admission, the TTS group was the most hypotensive and echocardiographic compromised, with lower incidence of obesity and diabetes mellitus (DM). Type 2 MI group was more prone to hypertension and had a similar incidence of DM and diastolic dysfunction compared to type 1 MI. However, compared to type 1 MI, type 2 MI patients received less frequent DAPT, nitrates, beta–blockers, and statins upon discharge. The MINOCA group received therapy similar to type 1 MI. Over a median follow–up of 62 [30–102] months, 358 patients reached the primary endpoint, 84 had hHF, 76 had AF/TIA/stroke, and 253 died. At Kaplan–Meier analysis, type 2 MI patients were more likely to reach the primary endpoint, following type 1 MI (Fig.1). TTS group had the best outcomes (p<0.01) for death (p<0.01) and HFh. (p<0.01), while type 2 MI had higher probability of developing AF/TIA/stroke (p<0.01) (Fig.2). Cox Regression analysis confirmed type 1 MI as a predictor of worse outcomes compared to other groups, after adjustment for male gender, older age, DM, anemia, reduced systolic function, high C–reactive protein, left bundle branch block, and statins on discharge (Fig.3). Conclusions Critical coronary disease is confirmed to have the worst prognosis. Although type 2 MI had similar clinical characteristics as type 1 MI, the former was more burdened by arrhythmic and embolic events and diverged in therapy at the time of discharge.