{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:04:01Z","timestamp":1760123041105,"version":"3.40.5"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Myocardial infarction with nonobstructive coronary arteries (MINOCA) is an underrecognized clinical problem in patients presenting with acute coronary syndrome. Various clinical disorders lead to MINOCA thus making treatment and diagnosis a challenge. We aimed to compare the clinical factors and outcomes of patients with MINOCA versus obstructive disease [myocardial infarction due to coronary artery disease (MI-CAD)] in a largely rural health system.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Between May 1, 2009 and June 24, 2019, all consecutive ST-segment elevation myocardial infarction patients at Essentia Health were prospectively examined. We categorized patients into MI-CAD (obstructive plaque \u2265 50% with revascularization) or MINOCA (obstructive plaque &lt; 50% with exclusion of other alternative cause). Outcomes included 30-day and 1-year all-cause mortality, 30-day all-cause readmission and 30-day cardiac readmission.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>There were 2170 patients included in the study; 2097 (96.6 %) had MI-CAD and 73 (3.4%) met the definition of MINOCA. Within the MINOCA group, the 3 most common presentations were supply\u2013demand mismatch (28.8%), spontaneous coronary artery dissection (9.6%), and other etiology (60.3%). Only 10 (13 %) MINOCA patients had cardiac magnetic resonance imaging studies obtained within 6 months. MINOCA patients were younger 61.6 versus 63.4 years with higher left ventricular function 51.6% versus 50.4% with less likelihood of prior myocardial infarction 4.1% versus 15.5% or congestive heart failure 2.7% versus 6.3% (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05). Compared with MI-CAD patients, MINOCA patients had similar 30-day mortality (7.1% vs. 8.2%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.70), 1-year mortality (10.4% vs. 8.2 %; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.55), and 30-day cardiac readmission (8.7% vs. 9.6%; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.29). MINOCA patients were less likely to be discharged on aspirin, betablockers, angiotensin-converting enzyme inhibitor\/angiotensin receptor blockers, or statins (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Though there was no difference in readmission and mortality between MINOCA and MI-CAD; use of secondary prevention medications and cardiac rehabilitation referral was low in MINOCA patients. Prospective studies will be relevant to assess effective medical therapy to improve outcomes in MINOCA patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/hpc.0000000000000249","type":"journal-article","created":{"date-parts":[[2020,12,19]],"date-time":"2020-12-19T05:40:38Z","timestamp":1608356438000},"page":"108-113","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence, Clinical Factors, and Outcomes Associated With Myocardial Infarction With Nonobstructive Coronary Artery"],"prefix":"10.1097","volume":"20","author":[{"given":"Katie","family":"Schmitz","sequence":"first","affiliation":[{"name":"University of Minnesota Medical School, Duluth Campus, Duluth, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Groth","sequence":"additional","affiliation":[{"name":"Essentia Health Heart and Vascular Center, Duluth, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Mullvain","sequence":"additional","affiliation":[{"name":"Essentia Health Heart and Vascular Center, Duluth, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colleen","family":"Renier","sequence":"additional","affiliation":[{"name":"Essentia Institute for Rural Health, Duluth, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oludamilola","family":"Oluleye","sequence":"additional","affiliation":[{"name":"Essentia Health Heart and Vascular Center, Fargo, ND."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Benziger","sequence":"additional","affiliation":[{"name":"Essentia Health Heart and Vascular Center, Duluth, MN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2020,11,25]]},"reference":[{"key":"R1-20250506","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.15420\/ecr.2019.13","article-title":"MI with non-obstructive coronary artery presenting with STEMI: a review of incidence, aetiology, assessment and treatment.","volume":"15","author":"Gue","year":"2020","journal-title":"Eur Cardiol"},{"key":"R2-20250506","doi-asserted-by":"crossref","first-page":"e891","DOI":"10.1161\/CIR.0000000000000670","article-title":"Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association.","volume":"139","author":"Tamis-Holland","year":"2019","journal-title":"Circulation"},{"key":"R3-20250506","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.114.011201","article-title":"Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries.","volume":"131","author":"Pasupathy","year":"2015","journal-title":"Circulation"},{"key":"R4-20250506","doi-asserted-by":"crossref","first-page":"e009174","DOI":"10.1161\/JAHA.118.009174","article-title":"Presentation, clinical profile, and prognosis of young patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): results from the VIRGO study.","volume":"7","author":"Safdar","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"R5-20250506","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.amjmed.2018.10.007","article-title":"Reinfarction in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA): coronary findings and prognosis.","volume":"132","author":"Nordenskj\u00f6ld","year":"2019","journal-title":"Am J 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National Center for Health Statistics"},{"key":"R11-20250506","doi-asserted-by":"crossref","first-page":"e003443","DOI":"10.1161\/CIRCOUTCOMES.116.003443","article-title":"Mortality of myocardial infarction by sex, age, and obstructive coronary artery disease status in the ACTION Registry-GWTG (acute coronary treatment and intervention outcomes network registry-get with the guidelines).","volume":"10","author":"Smilowitz","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"R12-20250506","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.amjcard.2012.11.011","article-title":"Long-term prognosis of patients presenting with ST-segment elevation myocardial infarction with no significant coronary artery disease (from the HORIZONS-AMI trial).","volume":"111","author":"Larsen","year":"2013","journal-title":"Am J Cardiol"},{"key":"R13-20250506","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.ahj.2009.08.004","article-title":"Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC\/AHA guidelines (CRUSADE) quality improvement initiative.","volume":"158","author":"Gehrie","year":"2009","journal-title":"Am Heart J"},{"key":"R14-20250506","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1016\/j.amjcard.2014.02.015","article-title":"Effects of angiotensin-converting enzyme inhibitors and beta blockers on clinical outcomes in patients with and without coronary artery obstructions at angiography (from a Register-Based Cohort Study on Acute Coronary Syndromes).","volume":"113","author":"Manfrini","year":"2014","journal-title":"Am J Cardiol"},{"key":"R15-20250506","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1161\/CIRCULATIONAHA.116.026336","article-title":"Medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease.","volume":"135","author":"Lindahl","year":"2017","journal-title":"Circulation"},{"key":"R16-20250506","doi-asserted-by":"crossref","first-page":"53","DOI":"10.15585\/mmwr.mm6702a1","article-title":"Current cigarette smoking among adults - United States, 2016.","volume":"67","author":"Jamal","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"R17-20250506","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1007\/s11239-019-01919-5","article-title":"MINOCA presenting with STEMI: incidence, aetiology and outcome in a contemporaneous cohort.","volume":"48","author":"Gue","year":"2019","journal-title":"J Thromb Thrombolysis"},{"key":"R18-20250506","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/j.ahj.2006.02.035","article-title":"Prevalence, predictors, and outcomes of patients with non-ST-segment elevation myocardial infarction and insignificant coronary artery disease: results from the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC\/AHA Guidelines (CRUSADE) initiative.","volume":"152","author":"Patel","year":"2006","journal-title":"Am Heart J"},{"key":"R19-20250506","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/ehjqcco\/qcv014","article-title":"Angina frequency after acute myocardial infarction in patients without obstructive coronary artery disease.","volume":"1","author":"Grodzinsky","year":"2015","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"R20-20250506","article-title":"Coronary optical coherence tomography and cardiac magnetic resonance imaging to determine underlying causes of MINOCA in women [published online ahead of print, 2020 Nov 14].","author":"Reynolds","year":"2020","journal-title":"Circulation"},{"key":"R21-20250506","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/j.jcmg.2018.12.023","article-title":"Prognostic role of CMR and conventional risk factors in myocardial infarction with nonobstructed coronary arteries.","volume":"12","author":"Dastidar","year":"2019","journal-title":"JACC Cardiovasc Imaging"},{"key":"R22-20250506","doi-asserted-by":"crossref","first-page":"e523","DOI":"10.1161\/CIR.0000000000000564","article-title":"Spontaneous coronary artery dissection: current state of the science: a scientific statement from the American Heart Association.","volume":"137","author":"Hayes","year":"2018","journal-title":"Circulation"},{"key":"R23-20250506","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.tcm.2017.12.004","article-title":"Spontaneous coronary artery dissection (SCAD): the underdiagnosed cardiac condition that plagues women.","volume":"28","author":"Lebrun","year":"2018","journal-title":"Trends Cardiovasc Med"}],"container-title":["Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000249","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T19:03:34Z","timestamp":1746558214000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/HPC.0000000000000249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,25]]},"references-count":23,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1097\/hpc.0000000000000249","relation":{},"ISSN":["1535-282X"],"issn-type":[{"type":"print","value":"1535-282X"}],"subject":[],"published":{"date-parts":[[2020,11,25]]}}}