Journal Article

The value of a new cardiac magnetic resonance imaging protocol in Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) – a case-control study using historical controls from a previous study with similar inclusion criteria

Sörensson, P., Y-Hassan, S., Sundqvist, M., Jensen, J., Henareh, L., Spaak, J., Cederlund, K., Ugander, M., Daniel, M., Lyngå, P., Agewall, S., Caidahl, K., Sarkar, N., Maret, E., Tornvall, Per, Brolin, E. B., Collste, O., Ekenbäck, C., Hofman-Bang, C.

2017

Overview

Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is common with a prevalence of 6% of all patients fulfilling the diagnosis of myocardial infarction. MINOCA should be considered a working diagnosis. Cardiac Magnetic Resonance (CMR) imaging has recently been suggested to be of great value to determine the cause behind MINOCA. The objectives of this paper are to describe the rationale behind the second Stockholm Myocardial Infarction with Normal Coronaries (SMINC-2) study and to discuss the protocol for investigation of MINOCA patients in the light of the recently published position paper from the European Society of Cardiology. Methods The SMINC-2 study is an open non-randomised study using historical controls for comparison. The primary aim is to prove that MINOCA patients investigated with the latest CMR imaging technique can achieve a diagnosis in 70% of all cases entirely by imaging. By including 150 patients we will have >80% chance to prove that the diagnostic accuracy can be improved by 20 absolute % with a p -value of less than 0.05 when compared with CMR imaging in the SMINC-1 study. Furthermore, in addition to invasive coronary angiography, coronary arteries are evaluated by computed tomography angiography to investigate coronary causes and questionnaires are used to describe Quality-of-Life (QoL). By January 1st 2017, 75 patients have been included. Discussion Whether CMR imaging can provide a diagnosis to an adequate proportion of MINOCA patients is unknown. Well-defined inclusion and exclusion criteria will be used to compare a MINOCA cohort from the population with an appropriate control group. Positive results are likely to influence future guidelines of the management of MINOCA. Furthermore, the study will give mechanistic insights into MINOCA in particular in patients with “true” myocardial infarction and describe QoL in this vulnerable group of patients. Trial registration Clinical Trials NCT02318498 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Angiography / Angiology / Automation / Blood Transfusion Medicine / Cardiac and Cardiovascular Systems / Cardiac magnetic imaging / Cardiac Surgery / Cardiology / Cardiomyopathy / Cardiovascular disease / Care and treatment / Case-Control Studies / Chronic obstructive pulmonary disease / Cine / Clinical Laboratory Medicine / Clinical Protocols / Computed tomography / Computed Tomography Angiography / Coronary Angiography - methods / Coronary artery / Coronary vessels / Coronary Vessels - diagnostic imaging / Diagnosis / Edema / Electrocardiography / Embolisms / Female / Heart / Heart attack / Heart attacks / Heart diseases / Historically Controlled Study / Humans / Internal Medicine / Kardiologi / Klinisk laboratoriemedicin / Magnetic Resonance Imaging / Magnetic Resonance Imaging, Cine / Male / Medical imaging / Medicine / Medicine & Public Health / Middle Aged / Myocardial infarction / Myocardial Infarction - diagnostic imaging / NMR / Non-coronary artery cardiac disease / Non-obstructive coronaries / Nuclear magnetic resonance / Predictive Value of Tests / Quality of Life / Research Design / Studies / Study Protocol / Surveys and Questionnaires / Sweden / Task forces / Tomography / Veins & arteries