Multi-modality imaging in women with myocardial infarction with nonobstructive coronary arteries (MINOCA) identified an underlying cause of myocardial infarction (MI) in a large majority of patients, according to findings from the HARP-MINOCA study presented Nov. 14 during AHA 2020 and simultaneously published in Circulation. Researchers noted the results may also have implications for secondary prevention in this patient population.

The prospective, multicenter, international study enrolled 301 women with a clinical diagnosis of MI. Researchers then performed coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (CMR) to assess mechanisms of MINOCA. Of the women enrolled, 170 were diagnosed with MINOCA and 145 had adequate OCT image quality for analysis. Of these, 116 women underwent CMR.

Presenting the results, Harmony R. Reynolds, MD, FACC, noted that a cause of MINOCA was identified in 84.5% of the women who underwent multi-modality imaging (98/116), compared with either OCT or CMR alone. Specifically, a definite or possible culprit lesion was identified by OCT in 46.2% (67/145) of participants, while CMR was abnormal in 74.1% (86/116) of participants. An ischemic pattern of CMR abnormalities (infarction or myocardial edema in a coronary territory) was present in 53.4% of participants undergoing CMR (62/116), while a nonischemic pattern of CMR abnormalities (myocarditis, takotsubo syndrome ornon-ischemic cardiomyopathy) was present in 20.7% (24/116).

According to Reynolds and colleagues, the "mechanisms of MINOCA are similar to MI with obstructive [coronary artery disease], namely, atherothrombosis with possible contribution of coronary artery spasm." Based on their findings, they suggest "identification of the etiology of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Magnetic Resonance Imaging, Nuclear Imaging

Keywords: AHA Annual Scientific Sessions, AHA20, Magnetic Resonance Imaging, Radiography, Dyslipidemias, Diagnostic Imaging

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