Additional heart imaging valuable for women with unexplained heart attacks

November 14, 2020

DALLAS, Nov. 14, 2020 -- Diagnostic imaging techniques were able to find the underlying cause of heart attack in many women who had no major artery blockage, according to late- breaking research presented today at the American Heart Association's Scientific Sessions 2020. The virtual meeting is Friday, November 13-Tuesday, November 17, 2020, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science for health care worldwide.

Previous research has found that up to one in 10 heart attacks among adults is classified as MINOCA, or myocardial infarction with non-obstructive coronary arteries, as determined by an angiogram (heart x-ray). Women are three times more likely to have MINOCA than men, and these non-obstructive heart attacks are also twice as common in non-white patients than white patients.

The Women's Heart Attack Research Program (HARP) is an international, multi-center study to assess the mechanisms of MINOCA and to try to find the cause of the heart attack in these patients. The study enrolled 301 women who experienced a heart attack but who did not have prior obstructive coronary artery disease and had no visible blockages on an angiogram. Their median age was 60 years, and 50% were non-Hispanic whites.

"Our findings are important because women (or men) with MINOCA have historically been told that since the angiogram is OK, they never had a heart attack. This is entirely wrong for about two-thirds of the women who had both imaging tests, and misleading for one-quarter of the women because we found they had another problem that was not related to blood flow and could be diagnosed via cardiac MRI," said Harmony R. Reynolds, M.D., director of New York University Langone's Sarah Ross Soter Center for Women's Cardiovascular Research and an associate professor in the department of medicine at NYU Grossman School of Medicine in New York City.

In this study, women diagnosed with MINOCA received two additional imaging tests: The results of images from OCTs and cardiac MRIs explained why women had symptoms and blood tests consistent with heart attack for 84% of the study participants: "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," Reynolds said. "Additional imaging tests can get to the root of the problem and help health care professionals make an accurate heart attack diagnosis for women and to ensure they receive timely treatment."

While the study was not a clinical trial assessing treatments, Reynolds noted, "The results set the stage for future research to find out why women are more likely than men to have MINOCA when they have a heart attack and for clinical trials of treatments."

Reynolds noted that this study suggests identification of the underlying etiology of MINOCA is feasible and has the potential to guide medical therapy for secondary prevention.
Co-authors are Akiko Maehara, M.D.; Raymond Kwong, M.D.; Tara Sedlak, M.D.; Jacqueline Saw, M.D.; Nathaniel Smilowitz, M.D.; Ehtisham Mahmud, M.D.; Janet Wei, M.D.; Kevin Marzo, M.D.; Mitsuaki Matsumura, M.D.; Ayako Seno, M.D.; Anais Hausvater, M.D.; Caitlin Giesler, M.D.; Nisha Jhalani, M.D.; Catalin Toma, M.D.; Bryan Har, M.D.; Dwithiya Thomas, M.D.; Laxmi S. Mehta, M.D.; Jeffrey Trost, M.D.; Puja Mehta, M.D.; Bina Ahmed, M.D.; Kevin R. Bainey, M.D.; Yuhe Xia, M.S.; Hua Zhong, Ph.D.; Binita Shah, M.D.; Michael Attubato, M.D.; Sripal Bangalore, M.D.; Louai Razzouk, M.D.; Noel Bairey Merz, M.D.; Ki Park, M.D.; Ellen Hada; and Judith S. Hochman, M.D. Author disclosures are in the abstract.

The study was funded by the American Heart Association through a grant from the Go Red for Women Strategically Focused Research Network.

Session LBS.03 - Current Challenges in Coronary and Valve Disease

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Uncommon heart attack, found more often in women, needs a second look

AHA Scientific Statement:
Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease

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