MINOCA
Conditions
Keywords
cardiac magnetic resonance imaging, prognosis, Myocarditis
Brief summary
Myocardial Infarction (MI) with Non-Obstructive Coronary Arteries (MINOCA), occurring in 6-8% of MIs, refers to patients who experience a heart attack without obstructive coronary artery disease (CAD) or significant atherosclerosis. One of the challenges inherent to MINOCA lies in its propensity to mimic non-coronary-related pathologies, such as myocarditis or takotsubo. Thus, Cardiac Magnetic Resonance (MRI) imaging has been recommended as the central diagnostic tool for confirming MINOCA diagnosis while excluding the others. However, the resource-intensive nature of MRI, combined with its limited availability in hospitals, poses barriers to patient access and limits research activities that could produce significant impact. Therefore, this project's aim is to curate the largest dataset of suspected MINOCA patients with MRI, via a collaboration between Sweden's nationwide registry and South Australia's state-wide registry, to answer the following key questions: (i) What is prognosis of MINOCA, as confirmed by MRI? (ii) What are the characteristics and prognosis of patients who had MRI compared to those who did not? (iii) What clinical parameters are associated with MINOCA on MRI? This project will utilize DataSHIELD, an innovative platform that enables pooled statistical analysis of sensitive data without compromising individual-level privacy. This multicentre, comprehensive study will have a major impact on contemporary practice. It will be able to provide the significance of MINOCA diagnosis (myocardial scar on MRI), alongside identifying clinical factors associated with its occurrence and its correlation with long-term outcomes. This is crucial for informing clinical guidelines, policy decisions around reimbursement for MRI, and developing effective clinical trials to enhance the management of MRI-confirmed MINOCA patients
Interventions
DIAGNOSTIC_TESTCMR
No CMR
Sponsors
Uppsala University
University of Adelaide
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Discharge diagnosis of MINOCA - acute presentation with (a) universal criteria for acute MI (b) non-obstructive coronaries on angiography. 2. Cardiac MRI - at least within 3 months of acute presentation
Exclusion criteria
1. Patients without satisfactory images on cardiac MRI 2. Follow-up data not available (ie international visitors). 3. Suspicion of an alternative cause for presentation (such as sepsis, pulmonary embolus, primary cardiac arrhythmia or trauma) which would not be consistent with the label of MINOCA. 4. Clinically evident non-ischemic diagnoses - myocarditis, Takotsubo, other cardiomyopathies prior to CMR
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Experiencing Major Adverse Cardiovascular Events (MACE) | 36 Months | The proportion of participants experiencing the first occurrence of MACE, defined as all-cause mortality, cardiac mortality, myocardial infarction, unstable angina, heart failure hospitalization, or stroke following MINOCA. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants with Cardiac Mortality | 36 Months | Proportion of participants who experience death due to a cardiac cause following MINOCA |
| Percentage of Participants with Myocardial Infarction (Re-Infarction) | 36 Months | Proportion of participants who are re-admitted for myocardial infarction following MINOCA |
| Percentage of Participants with Hospital admission for Unstable Angina | 36 Months | Proportion of participants who are admitted for unstable angina following MINOCA. |
| Percentage of Participants Hospitalized for Heart Failure | 36 Months | The proportion of participants who require hospitalization due to heart failure following MINOCA |
| Percentage of Participants Experiencing a Stroke | 36 Months | The proportion of participants who experience a stroke following MINOCA |
| Percentage of Participants with All-Cause Mortality | 36 Months | Proportion of participants who experience death from any cause following MINOCA. |
| Percentage of Participants with Late Gadolinium Enhancement (LGE) Features on CMR Following suspected MINOCA | From CMR performed within 3 months from acute presentation | The proportion of participants with detectable LGE on cardiac magnetic resonance (CMR) , indicating myocardial fibrosis or necrosis. |
| Percentage of Participants with Abnormal Tissue Characteristics on CMR in Suspected MINOCA | From CMR performed within 3 months from acute presentation | The proportion of participants with suspected MINOCA who exhibit abnormal myocardial tissue characteristics on CMR, including myocardial edema, |
| Percentage of Participants with Evidence of Myocarditis on CMR in Suspected MINOCA | From CMR performed within 3 months from acute presentation | The proportion of participants with suspected MINOCA who have CMR findings consistent with myocarditis (e.g., myocardial edema, LGE patterns suggestive of inflammation). |
| Percentage of Participants with Evidence of Takotsubo Syndrome on CMR in Suspected MINOCA | From CMR performed within 3 months from acute presentation | The proportion of participants with suspected MINOCA who demonstrate CMR findings consistent with Takotsubo syndrome (e.g., apical ballooning, absence of LGE). |
| Percentage of Participants with Normal CMR Findings in Suspected MINOCA | From CMR performed within 3 months from acute presentation | The proportion of participants with suspected MINOCA who have no significant abnormalities on CMR, indicating no structural or ischemic myocardial injury. |
| Percentage of Participants Presenting to the Emergency Department with Chest Pain | 36 Months | The proportion of participants who present to the emergency department with chest pain, expressed as a percentage of the total study population. |
Countries
Australia
Outcome results
None listed