, Gökhan Aydın 2
, Ali Çoner 3
, Yasemin Kılavuz Doğan 4
, Özlem Arican Özlük 5
, Yunus Çelik 6
, Ismail Ungan 7
, Mustafa Tascanov 8
, Ramazan Düz 9
, Veli Polat 10
, Hakan Özkan 11
, Mehmet Özyaşar 12
, Kamil Tülüce 13
, Devrim Kurt 14
, Nurullah Çetin 13
, Murat Gül 15
, Sinan Inci 16
, Fatma Yilmaz Coskun 17
, Hasan Ari 5
, Megdi Zoghi 18
, Oktay Ergene 19
, Uğur Önsel Türk 20
2Health Sciences University, Balıkkesir Training and Research Hospital, Department of Cardiology, Balıkkesir, Turkey
3Başkent University Alanya Training and Research Center, Department of Cardiology, Antalya, Turkey
4Health Sciences University, Kayseri Training and Research Hospital, Department of Cardiology, Kayseri, Turkey
5Bursa Yüksek Ihtisas Training and Research Hospital, Department of Cardiology, Bursa, Turkey
6Kırıkkale Yüksek İhtisas Hospital, Department of Cardiology, Kırıkkale, Turkey
7Yalova state Hospital, Department of Cardiology, Yalova, Turkey
8Tokat Medicalpark Hospital, Department of Cardiology, Tokat, Turkey
9Health Sciences University, Van Training and Research Hospital, Department of Cardiology, Van, Turkey
10Bakırköy Doctor Sadi Konuk Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
11Bursa Medicalpark Hospital, Department of Cardiology, Bursa, Turkey
12Karaman State Hospital,Department of Cardiology, Karaman, Turkey
13Çiğli Regional Training and Research Hospital,Department of Cardiology, İzmir, Turkey
14Giresun University Prof.Dr. A. İlhan Özdemir Training and Research Hospital, Department of Cardiology,Giresun, Turkey
15Aksaray University Research and Training Hospital, Department of Cardiology, Aksaray, Turkey
16Aksaray State Hospital,Department of Cardiology, Aksaray, Turkey
17Gaziantep University Faculty of Medicine, Department of Cardiology, Gaziantep, Turkey
18Ege University Faculty of Medicine, Department of Cardiology, İzmir, Turkey
19Dokuz Eylül University Faculty of Medicine, Department of Cardiology, İzmir, Turkey
20KardiyoRitm Heart Center, Department of Cardiology, İzmir, Turkey
Abstract
Objective: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a relatively new term that is characterized by clinical evidence of MI with normal or near-normal coronary arteries on coronary angiography (QCA). To date, there have been no population-based studies on the prevalence of MINOCA in Turkey. The aim of this nationwide study was to document the prevalence and demographics of MINOCA in a Turkish population.
Methods: MINOCA-TR is national, multi-center, prospective, all-comer study that was conducted in 32 hospitals. All consecutive patients who were ≥18 years old, diagnosed with MI according to the Third Universal Definition of Myocardial Infarction, and had undergone QCA were included in the study. Patients with stable coronary artery disease, unstable angina pectoris, a history of revascularization, and type 4/5 MI were excluded.
Results: A total of 1793 patients who were diagnosed with MI and had undergone QCA were screened between March 2018 and October 2018, of whom 1626 (mean age: 61.5±12.5 years, 70.7% male) were enrolled from 32 centers. The prevalence of MINOCA was 6.7% (n=109) in the overall study population. Compared with non-MINOCA patients, those with MINOCA were younger, had a higher prevalence of the female gender, and had a history of flu. The percentages of current smokers, ST-segment elevated myocardial infarction patients, and those with a history of hypertension, diabetes mellitus, and hyperlipidemia were significantly lower in MINOCA patients (p<0.05, for all). Also, the median left ventricular ejection fraction as seen on echocardiography and the ratio of Killip Class I status at presentation was significantly higher in MINOCA patients than in non-MINOCA patients (p<0.001). Patients with MINOCA received a preload dose of P2Y12 antagonist before QCA less often than non-MINOCA patients (p<0.001).
Conclusion: The prevalence of MINOCA in Turkey is 6.7% in patients who were admitted with MI. Also, as compared to non-MINOCA patients, the MINOCA patients were exposed to fewer traditional risk factors of coronary artery disease.