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Canadian Journal of Cardiology

One-Year Prospective Follow-up of Women With INOCA and MINOCA at a Canadian Women’s Heart Centre

Published:September 06, 2022DOI:https://doi.org/10.1016/j.cjca.2022.07.005

      Abstract

      Background

      Many women with cardiac chest pain and ischemia or myocardial infarction have no obstructive coronary artery disease (INOCA or MINOCA). Studies suggest that these patients have a decreased quality of life and are at increased risk of cardiovascular events. Our study reports 1-year quality of life, frequency of angina, and outcomes following entry into a multidisciplinary Women’s Heart Centre (WHC).

      Methods

      Patients with INOCA and MINOCA completed questionnaires on baseline demographics and clinical presentation. At 1-year, frequency of chest pain, quality of life, depression and anxiety symptoms, and cardiovascular outcomes were reported and compared with baseline.

      Results

      A total of 154 women with nonobstructive coronary artery disease were included in this study (112 patients with INOCA and 42 with MINOCA). Median age was 59 years, and the most common referral was for chest pain (94% in INOCA and 66% in MINOCA). At baseline, 64% of patients with INOCA and 43% of patients with MINOCA did not have specific diagnoses. Following investigations in the WHC, 71.4% of patients with INOCA established a new or a changed diagnosis (most common was coronary microvascular dysfunction at 68%), whereas 60% of patients with MINOCA established new or changed diagnoses (the most common of which was coronary vasospasm at 60%). At 1-year, participants had significantly decreased chest pain, improved quality of life, and improved mental health.

      Conclusions

      A multidisciplinary WHC significantly increases the yield of a specific diagnosis in patients with INOCA and MINOCA. Further, attending a WHC could significantly improve the clinical and psychological outcomes of women with INOCA and MINOCA.

      Résumé

      Contexte

      De nombreuses femmes souffrent de douleurs thoraciques et d'ischémie ou d'infarctus du myocarde sans obstruction coronarienne (INOCA ou MINOCA). Des études suggèrent que ces patientes ont une qualité de vie réduite et présentent un risque accru d'événements cardiovasculaires. Notre étude fait état de la qualité de vie à un an, de la fréquence de l'angine et des pronostics après l'entrée dans un centre multidisciplinaire de cardiologie féminine (CCF).

      Méthodes

      Les patientes atteintes d'INOCA et de MINOCA ont rempli des questionnaires portant sur les caracthéristiques démographiques de base et sur le portrait clinique. Après un an, la fréquence des douleurs thoraciques, la qualité de vie, les symptômes de dépression et d'anxiété et les observations d'ordre cardiovasculaire ont été rapportés et comparés aux données de base.

      Résultats

      Au total, 154 femmes atteintes d'une maladie coronarienne non obstructive ont été incluses dans cette étude (112 patientes avec INOCA et 42 avec MINOCA). L'âge médian était de 59 ans, et l'orientation la plus fréquente était pour cause de douleur thoracique (94 % pour INOCA et 66 % pour MINOCA). Au départ, 64 % des patientes atteintes d'INOCA et 43 % des patientes atteintes de MINOCA n'avaient pas de diagnostic spécifique. À la suite des investigations menées au CCF, 71,4 % des patientes atteintes d'INOCA ont reçu un nouveau diagnostic ou un diagnostic modifié (le plus fréquent étant une dysfonction microvasculaire coronaire à 68 %), tandis que 60 % des patientes atteintes de MINOCA ont reçu un nouveau diagnostic ou un diagnostic modifié (le plus fréquent étant le vasospasme coronarien à 60 %). Après un an, les participants présentaient une diminution significative des douleurs thoraciques, une meilleure qualité de vie et une meilleure santé mentale.

      Conclusions

      Un CCF multidisciplinaire augmente significativement l'effet favorable à l'issue d'un diagnostic spécifique chez les patients atteints d'INOCA et de MINOCA. En outre, la participation à un CCF pourrait améliorer de manière significative les pronostics cliniques et psychologiques des femmes atteintes d'INOCA et de MINOCA.

      Graphical abstract

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      Linked Article

      • INOCA and MINOCA: Are Women’s Heart Centres the Answer to Understanding and Management of These Increasing Populations of Women (and Men)?
        Canadian Journal of CardiologyVol. 38Issue 10
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          Cardiovascular disease (CVD) continues to be a leading cause of morbidity and mortality in women who have been underdiagnosed, undertreated, and under researched concerning prevention, diagnosis, and treatment of cardiac conditions that predominantly affect them.1 Notably, declines in CVD death rates have stalled in midlife women compared with those in men,1 suggesting sex-specific approaches might be needed. Ischemia with no obstructive coronary artery disease (INOCA) might affect up to 62% of women who undergo coronary angiography for suspected angina, with a higher prevalence in midlife women aged 45-65 years.
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