Three quarters of the women with abnormal OCT or cardiac MRI results had evidence of heart damage from reduced blood flow. This reduced blood flow was determined to be due to ruptured plaque or recently ruptured plaque in most cases. Two thirds of those with a culprit finding on the OCT had MRI evidence of heart damage. About one third of women with cardiac MRI evidence of heart attack did not have a ruptured plaque to explain the reduction in blood flow. The investigators suggest those women without a recently ruptured plaque and with MRI evidence of heart damage most likely had either artery spasm or a blood clot or plaque rupture in the artery that was not seen. This is a major difference in patients with MINOCA from typical patients with heart attack with badly blocked arteries, since nearly all typical heart attack is caused by plaque with blood clotting.
Based on cardiac MRI, one in five of patients with MINOCA was found to have an alternate, non-ischemic diagnosis, such as myocarditis, Takotsubo syndrome, or another cardiomyopathy. Patients with these diagnoses receive different treatment than patients with heart attack in general.
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For the remaining 16 percent of the women in the study, both the OCT and cardiac MRI scans were normal, and the cause of the heart attack was not found.
"These findings build upon our understanding of MINOCA and set the stage for the next frontier of women's cardiovascular care," says Dr. Reynolds. "Physicians no longer need to guess at the cause of heart attacks because we have the tools we need to correctly diagnose and successfully treat most patients."
In addition to Dr. Reynolds, other NYU Langone researchers involved with the study are Nathaniel R. Smilowitz, MD; Kevin P. Marzo, MD; Anais Hausvater, MD; Yuhe Xia, MS; Hua Zhong, PhD; Binita Shah, MD; Michael J. Attubato, MD; Sripal Bangalore, MD; Louai Razzouk, MD, MPH; Ellen Hada; and Judith S. Hochman, MD.
SOURCE NYU Langone HealthBack to HCB News