TCT-780 Higher One-Year Event Rates With Cardiac MRI–Selected Microvascular Dysfunction MINOCA: A Nationwide Matched Analysis

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Abstract

Background: Cardiac magnetic resonance (CMR) is a pillar of the diagnostic algorithm for myocardial infarction with non-obstructive coronary arteries (MINOCA), helping in the identification of underlying mechanisms including coronary microvascular dysfunction (CMD). Methods: We queried TriNetX for US nationwide adults with CMD diagnoses since 2016. Patients who underwent CMR before or after one months of the diagnosis formed CMR cohort; those who were diagnosed without CMR served as controls. Propensity-score matching yielded 350 patients per group with excellent balance (all SDs ≤0.015). Mean age was 59; 53 % were female; racial distribution: 66 % White, 19 % Black, 5 % Asian; 5 % identified as Hispanic. Hypertension (69 %) and diabetes (33 %) were equally prevalent. The primary endpoint was a composite of all-cause death, acute myocardial infarction or ischemic stroke from day 1 to 365. Results: During 1-year follow-up, the cardiac-MRI cohort experienced 160 primary events versus 112 among their matched controls. Kaplan–Meier analysis showed significantly lower event-free survival with MRI (47.1 % vs 63.1 %, p = 0.0003). Multivariable Cox regression that included CMD phenotype (MRI vs no-MRI) and potential confounders, cardiac MRI remained an independent predictor of the composite of all-cause death, acute MI or ischemic stroke (hazard ratio 1.55, 95 % CI 1.22–1.98). Heart-failure history and active smoking were additional significant covariates, whereas age, hypertension and hyperlipidemia were not. Thus, even after rigorous adjustment, patients selected for cardiac MRI had a 55 % higher risk of major events within the first year (Table 1). [Formula presented] Conclusion: Our findings indicate that CMR is underutilized in the diagnosis of CMD, probably more among the sicker patients which may explains higher complications rate among this group. This underscores the importance of following MINOCA diagnosis algorithm. Categories: CORONARY: Acute Coronary Syndromes

Volume

86

Issue

17

First Page

B340

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