In a series of over 300 women who had a heart attack without any major artery blockages, additional diagnostic imaging was able to determine the underlying cause of their heart attack in 84% of the cases. These results support a role for coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (MRI) in MINOCA patients and have the potential to guide medical therapy for secondary prevention.
Prof. Harmony Reynolds (New York University Grossman School of Medicine, USA) presented the Women’s Heart Attack Research Program (HARP) [1], an international, multicentre study to identify the cause of myocardial infarction with non-obstructive coronary arteries (MINOCA). MINOCA accounts for up to 10% of heart attacks. It is 3-times more prevalent in women than men and is overrepresented in women of colour.
In HARP-MINOCA, 301 women diagnosed with MINOCA received 2 additional imaging tests: OCT and cardiac MRI. Surprisingly, just adding these 2 imaging modalities identified the putative cause of 84% of the MINOCAs in this cohort. For example, 3/4 of the women with abnormal OCT or cardiac MRI had evidence of heart damage from reduced blood flow. Recently ruptured plaques were also identified, which had not been previously identified. In 21% of the women, the cardiac MRI showed myocarditis or another reason for heart dysfunction unrelated to artery blockage or blood clotting. For the remaining 16% of the women, both the OCT and MRI scans were normal, and the cause of the heart attack remained elusive.
Prof. Reynolds concluded: “Our findings demonstrate that even if the angiogram does not show substantial artery blockage, when women have symptoms and blood test findings consistent with a heart attack, it is likely a true heart attack and not heart inflammation. Additional imaging tests can get to the root of the problem and help healthcare professionals make an accurate heart attack diagnosis for women and to ensure they receive timely treatment.”
- Reynolds H, et al. Coronary OCT and Cardiac MRI to Determine Underlying Causes of Minoca in Women (HARP-MINOCA). LBS.03, Virtual AHA Scientific Sessions 2020, 13-17 Nov.
