ArticleJAMA network open2023
Mortality in ST-Segment Elevation Myocardial Infarction With Nonobstructive Coronary Arteries and Mimickers.
Article in JAMA network open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 14 citations in OpenAlex.
- Complex MINOCA With Myocardial Bridge, Vasospasm, and Microvascular Dysfunction in an HCM Patient.JACC. Case reports · 2026Article
- Performance of Artificial Intelligence-Powered ECG Analysis in Suspected ST-Segment Elevation Myocardial Infarction.JACC. Advances · 2026Article
- Cumulative Serum Endothelin-1 and Endothelin-3 Level Predicts 1-year Adverse Cardiac Events after ST-Elevation Acute Myocardial Infarction.The International journal of angiology : official publication of the International College of Angiology, Inc · 2026Article
- A narrative review of electrocardiogram manifestation of myocardial infarction with non-obstructive coronary arteries (MINOCA).Journal of thoracic disease · 2025Review
- Myocardial Infarction with Obstructive, Non-Obstructive, and Mimicking Conditions: Clinical Phenotypes, Diagnostic Imaging, Management, and Prognosis.Journal of clinical medicine · 2025Article
- Developing a Women's Heart Center With a Specialization in Coronary Microvascular and Vasomotor Dysfunction: If You Build It, They Will Come.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2024Review
- SCAI Expert Consensus Statement on the Management of Patients With STEMI Referred for Primary PCI.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Article
- Effects of statins in patients with coronary artery spasm: A nationwide population-based study.Clinical and translational science · 2024Article
- MINOCA: A Pathophysiological Approach of Diagnosis and Treatment-A Narrative Review.Biomedicines · 2024Review
Corrections and comments
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Authors and funding
18 authors at 5 institutions in 1 country.
Funding
Abstract
Importance: The clinical characteristics and prognosis of patients with ST-segment elevation myocardial infarction (STEMI) with nonobstructive coronaries (MINOCA) are largely unknown. Objective: To assess differences in 5-year mortality in patients presenting with STEMI due to MINOCA and MINOCA mimickers as compared with obstructive disease. Design, Setting, and Participants: A retrospective analysis of a prospective registry-based cohort study of consecutive STEMI activations at 3 regional Midwest STEMI programs. STEMI without a culprit artery and elevated troponin levels were categorized as MINOCA (absence of coronary artery stenosis >50% and confirmed or suspected coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) or MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, or nonischemic cardiomyopathy). Data were analyzed from March 2003 to December 2020. Main Outcomes and Measures: Adjusted Cox regression analysis was used to assess 5-year mortality risk in STEMI presenting with MINOCA and MINOCA mimickers in comparison with obstructive disease. Results: Among 8560 consecutive patients with STEMI, mean (SD) age was 62 (14) years, 30% were female (2609 participants), and 94% were non-Hispanic White (4358 participants). The cohort included 8151 patients with STEMI due to obstructive disease (95.2%), 120 patients with MINOCA (1.4%), and 289 patients with MINOCA mimickers (3.8%). Patients were followed up for a median (IQR) of 7.1 (3.6-10.7) years. Patients with MINOCA and MINOCA mimickers were less likely to be discharged with cardiac medications compared with obstructive disease. At 5-year follow-up, mortality in STEMI presenting with obstructive disease (1228 participants [16%]) was similar to MINOCA (20 participants [18%]; χ21 = 1.1; log-rank P = .29) and MINOCA mimickers (52 participants [18%]; χ21 = 2.3; log-rank P = .13). In adjusted Cox regression analysis compared with obstructive disease, the 5-year mortality hazard risk was 1.93 times higher in MINOCA (95% CI, 1.06-3.53) and similar in MINOCA mimickers (HR, 1.08; 95% CI, 0.79-1.49). Conclusions and Relevance: In this large multicenter cohort study of consecutive clinical patients with STEMI, presenting with MINOCA was associated with a higher risk of mortality than obstructive disease; the risk of mortality was similar in patients with MINOCA mimickers and obstructive disease. Further investigation is necessary to understand the pathophysiologic mechanisms involved in this high-risk STEMI population.
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