Arq. Bras. Cardiol. 2024; 121(5): e20240307

Prognostic Value of PRECİSE DAPT Score in MINOCA Patients with Acute Coronary Syndrome

Henrique Tria Bianco

DOI: 10.36660/abc.20240307i

This Short Editorial is referred by the Research article "Valor Prognóstico da Escore PRECİSE DAPT em Resultados de Curto e Longo Prazo em Pacientes MINOCA com Síndrome Coronariana Aguda".

In recent decades, the therapeutic management of acute myocardial infarction (AMI) has progressed substantially due to increasing innovations. Thus, the development and understanding of biomarkers, such as troponin, has emerged as a more accurate diagnostic marker of myocardial injury and is now the cornerstone of contemporary definitions of AMI. development of reperfusion therapies for ST-segment elevation myocardial infarction (STEMI), initially involving intravenous thrombolytic therapy and later primary percutaneous coronary interventions when the former found to have less effect on restoring coronary blood flow. angiography and improving clinical results. However, approximately 5% to 6% of AMI cases present with coronary arteries without obstructive lesions (i.e., lesions with more than 50% stenosis), hereinafter referred to as MINOCA, myocardial infarction with nonobstructive coronary arteries. Data from large registries suggest a prevalence of MINOCA between 2 and 10%, depending on the cohort studied and the diagnostic criteria used. The largest of these studies examined patients with STEMI from the CRUSADE registry and reported that female sex and younger age were the only independent clinical predictors of MINOCA.^–

An important aspect in the evaluation of patients with apparent MINOCA is to exclude non-ischemic causes, such as pulmonary embolism, chronic renal failure, chronic heart failure, myocarditis, cardiomyopathies (infiltrative, takotsubo, peripartum…), stroke, septic shock, syndrome from acute respiratory distress, cardiac trauma (including iatrogenic), severe burns, chemotherapy agents, and strenuous exercise. Coronary artery spasm is another important cause of transient occlusion of an epicardial artery and the hallmark of variant or vasospastic angina. The presence of transient ST-segment changes during chest pain that responds to nitrate therapy is consistent with the diagnosis. Clearly, more studies are needed in this area, especially because vasospastic angina is associated with an increased risk of AMI/death.^–

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