P3680Treatment administrated to patients with myocardial infarction with non-obstructive coronary arteries in the real world and its impact on prognosis

Abstract

Background: The 2016 European Society of Cardiology Working Group position paper (ESC-WGPP) on Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) recommend treating pharmacologically this entity like infarcts with obstructive coronary disease, mainly with dual antiplatelet therapy (DAT), betablockers, Angiotensin Converter Enzyme (ACE) Inhibitors and statins. The aim of this study is to evaluate the pharmacological treatment in MINOCA patients (pts) and its implication on their prognosis. Methods: Analytical and observational study developed in a University Hospital, which covers 220.000 individuals. We analyzed data about the treatment of all consecutive MINOCA patients (pts) admitted to our center during two years. We used the definitions 2016 ESC-WGPP on MINOCA. Treatment prescribed was the one considered by their doctors. We compared the MINOCA patients with a group of 84 consecutive patients diagnosed of Myocardial Infarction Related to Obstructive Coronary Arteries during the lasts 6 months of 2016 in the same hospital. We recorded specific information about treatment prescribed after hospitalization. Follow up analysis included death from any cause, major adverse cardiovascular events ([MACE], a composite of a recurrence of myocardial infarction, stroke or transient ischemic attack or death from any cardiovascular cause), readmissions and functional class worse than II. Median follow up was 9 months. Results: 63 of 679 patients initially admitted for acute myocardial infarction were classified as MINOCA (incidence 9.27%). DAT was prescribed in 19.4% of MINOCA patients and in 88.8% of the obstructive related group (p<0.01). It was also statistically significant the difference between the two groups (MINOCA pts vs obstructive pts) in the rate of prescriptions of betablockers (61.3 vs 88.7%, p<0.01), ACE inhibitors (38.7 vs 71.3%, p<0.01) and statins (53.2% vs 93.8%, p<0.01). During the follow up, there was no mortality in the MINOCA group, with an incidence of MACE of 8.7%. The main difference was found between patients with MINOCA and treatment with statins, who were linked to a lower proportion of worse functional class (14.3 vs 56.9%, p0<0.05) than those who did not receive statins. MINOCA patients who received betablockers had less MACE (2.7 vs 26.7%, p<0.05). Those who received DAT tended to have a lower rate of worse functional class (p=0.2) Conclusion: Despite the recommendations of the 2016 ESC-WGPP on MINOCA, in the real world the pharmacological treatment is characterized by a lower use of beta-blockers, ACE inhibitors, DAT and statins in MINOCA pts compared to obstructive pts. This study suggests that following the 2016 ESC-WGPP on MINOCA recommendations is linked with a better prognosis. Further studies are necessary in this subject to confirm it.