Researchers use multi-modality imaging to learn more about MINOCA
New research found underlying causes in nearly eight out of ten patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) using optical coherence tomography (OCT) and cardiac magnetic resonance imaging (MRI).
Lead author Harmony Reynolds, MD, director of the cardiovascular clinical research center at NYU Langone Health, presented the data at ACC.26 in New Orleans. She discussed her team's findings during an exclusive interview with Cardiovascular Business.
"MINOCA affects predominantly women, but it also affects men. We wanted to understand better what's causing this, because it's not one thing,” Reynolds explained.
MINOCA has long posed a diagnostic challenge. These patients present with heart attack symptoms, but when they are sent to the cath lab, angiography does not show any clear signs of coronary artery obstruction. Reynolds said the condition can be caused by a spectrum of underlying mechanisms, including atherosclerotic plaque rupture, coronary spasm and other vascular abnormalities.
To better define these causes, the study combined high-resolution OCT imaging of the coronary arteries with MRI assessments of the heart muscle.
“We use two different imaging tests in order to come to a final diagnosis,” Reynolds said. “Putting them together, we were able to find an underlying cause in 79% of patients.”
The analysis showed that 59% of patients had a true myocardial infarction, while 20% had conditions that mimic heart attacks, such as myocarditis or non-ischemic cardiomyopathy.
“One in five is a mimicking condition. It looks like a heart attack, but if you do MRI, it's not a heart attack at all,” Reynolds explained.
Despite MINOCA being up to three times more common in women, the study found no significant sex differences in the underlying causes identified through imaging. She said this finding challenges assumptions that the mechanisms driving MINOCA may differ substantially between men and women.
The study builds on earlier work published in 2020 that focused on women and now expands the dataset to include men, nearly doubling the amount of evidence available on this topic.
The findings carry important clinical implications. In years past, patients with MINOCA were often discharged without any therapy because no blockage was found. However, Reynolds emphasized that this approach is risky and physicians need to dig deeper with additional testing.
“The one-year rate of major adverse cardiovascular events after a MINOCA event is 10%, and the four year rate is 24%,” she said. “So we should not be dismissing these patients and telling them they're fine just because they don't have a badly blocked artery.”
These findings were also published in Circulation.[1]
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]