Myocarditis in Relation to Angiographic Findings in Patients With Provisional Diagnoses of MINOCA

Authors	HAUSVATER A. SMILOWITZ N. R. LI B. Y. Z. REDEL-TRAUB G. QUIEN M. QIAN Y. Z. ZHONG J. NICHOLSON J. M. CAMASTRA G. BIERE L. PANOVSKÝ Roman SA M. GERBAUD E. SELVANAYAGAM J. B. AL-MALLAH M. H. EMRICH T. REYNOLDS H. R.
Year of publication	2020
Type	Article in Periodical
Magazine / Source	JACC-CARDIOVASCULAR IMAGING
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.sciencedirect.com/science/article/pii/S1936878X20303405?via%3Dihub
Doi	http://dx.doi.org/10.1016/j.jcmg.2020.02.037
Keywords	cardiac magnetic resonance; myocardial infarction; myocarditis
Description	OBJECTIVES The aim of this study was to determine the prevalence of myocarditis among patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) in relation to the angiographic severity of non-obstructive coronary artery disease (CAD). BACKGROUND MINOCA represents about 6% of all cases of acute myocardial infarction. Myocarditis is a diagnosis that may be identified by cardiac magnetic resonance (CMR) imaging in patients with a provisional diagnosis of MINOCA. METHODS A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients with nonobstructive CAD or normal coronary arteries. Study-level and individual patient data meta-analyses were performed using fixed- and random-effects methods. RESULTS Twenty-seven papers were included, with 2,921 patients with MINOCA; CMR findings were reported in 2,866 (98.1%). Myocarditis prevalence was 34.5% (95% confidence interval [CI]: 27.2% to 42.2%) overall and was numerically higher in studies that defined MINOCA as myocardial infarction with angiographicalty normal coronary arteries compared with a definition that permitted nonobstructive CAD (45.9% vs. 32.3%; p = 0.16). In a meta-analysis of individual patient data from 9 of the 27 studies, the pooled prevalence of CMR-confirmed myocarditis was greater in patients with angiographically normal coronary arteries than in those with nonobstructive CAD (51% [95% CI: 47% to 56%] vs. 23% [95% CI: 18% to 27%]; p < 0.001). Men and younger patients with MINOCA were more likely to have myocarditis. Angiographicatly normal coronary arteries were associated with increased odds of myocarditis after adjustment for age and sex (adjusted odds ratio: 2.30; 95% CI: 1.12 to 4.71; p = 0.023). CONCLUSIONS Patients with a provisional diagnosis of MINOCA are more likely to have CMR findings consistent with myocarditis if they have angiographically normal coronary arteries. (C) 2020 by the American College of Cardiology Foundation.