Myocarditis or ``true'' infarction by cardiac magnetic resonance in patients with a clinical diagnosis of myocardial infarction without obstructive coronary disease: A meta-analysis of individual patient data

Objective: Myocardial Infarction with Non-Obstructed Coronary Arteries (MINOCA) is common, but the causes are to a large extent unknown. Thus, we aimed to study the prevalence of myocarditis and ``true'' myocardial infarction determined by cardiac magnetic resonance (CMR) imaging in MINOCA patients, and risk markers for these two conditions in this population. Methods: A search was made in the PubMed and Cochrane databases using the search terms ``Myocardial infarction'', ``Coronary angiography'', ``Normal coronary arteries'' and ``MRI''. All relevant abstracts were read and seven of the studies fulfilled the inclusion criteria; studies describing case series of patients fulfilling the diagnosis of acute myocardial infarction with normal or non-obstructive coronary arteries on coronary angiography that were investigated with CMR imaging. Data from five of these studies are presented. Results: A total of 556 patients from 5 different sites were included. Fifty-one percent were men with a mean age of 52 +/- 16 years. Thirty-three per cent of the patients had myocarditis (n = 183), whereas 21% of the patients had infarction on CMR (n = 115). Young age and a high CRP were associated with myocarditis whereas male sex, treated hyperlipidemia, high troponin ratio and low CRP were associated with ``true'' myocardial infarction. Conclusion and relevance: The results of this meta-analysis of individual data showed that myocarditis and ``true'' myocardial infarction are common in MINOCA when determined by CMR imaging. This information emphasizes the importance of performing CMR imaging in MINOCA patients and can be used clinically to guide diagnostics and treatment of MINOCA patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.