Quality of Care and Profitability of Diagnostic Tests in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries in the Real World

One of the knowledge frontiers in cardiology is settled at the myocardial infarction with nonobstructive coronary arteries (MINOCA). We aim to analyze the quality of care of these patients, based in the tests performed and their profitability.

During two years, 63 MINOCA pts were recorded. We also collected 84 consecutive patients with obstructive coronary desease. ESC Working Group Position Paper on MINOCA definition was used. Data about diagnostic tests performed and their utility to find the pathophysiological mechanism was included. During follow-up (median of 9 months) we analyzed death from any cause, recurrence of myocardial infarction, readmission and functional class worse than II.

There were no differences in the proportion of emergent coronariography. Cardiac Magnetic Resonance (CMR) was performed more frequently (39.7% vs 3.6%, p<0.001). It was diagnostic in 48% of the cases. MINOCA patients had an average of 10.2±2.2 hospitalization days, higher than the obstructive related group (7.4±0.6 days, p<0.02). The average time until coronariography was higher in the MINOCA group (53±12.4 vs 21±3 hours, p<0.01). The duration of admission was associate with a worse functional class (p<0.01) and delay to coronariography with higher tax of rehospitalization (p<0.01)

MINOCA patients have greater consumption of resources due to diagnostic tests and duration of hospitalization. That is related with the need of delving into exhaustive diagnosis tests in order to know the pathophysiological mechanism of MINOCA. Our study suggests that CMR is the key stone in this field. Further studies are necessary to offer the best possible management to these patients.