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      Management of myocardial infarction with non-obstructive coronary arteries (MINOCA) in Germany: a single-center study on hospital resources and healthcare economics

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          Abstract

          Background

          Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) present as a main feature ≤50% stenosis upon angiography despite clinical symptoms and biomarker elevation related to acute coronary syndrome. Due to broad availability of high sensitivity troponin testing as well as invasive and non-invasive imaging, this clinical entity receives increasing clinical awareness.

          Objective

          We aimed to investigate the in-hospital work flow and economic impact of MINOCA vs. MICAD (myocardial infarction with obstructive coronary artery disease) patients and related clinical outcomes in a single-center patient collective of a large university heart center in Germany.

          Methods

          We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017–2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography for acute coronary syndrome. Associated in-hospital costs, procedural and various clinical parameters as well as timelines and parameters of work-flow were obtained.

          Results

          After screening of 3,021 patients, we included 660 patients with acute coronary syndrome. Of those, 118 patients were attributed to the MINOCA-group. 542 patients presented with a “classical” myocardial infarction (MICAD group). MINOCA patients were less frail, more likely female, but showed no relevant difference in age or other selected comorbidities except for fewer cases of diabetes. In-hospital mortality (11% vs. 0%; p < 0.001) and 30-day mortality (17.3% vs. 4.2%; p < 0.001) after the index event were significantly higher in the “classical” myocardial infarction group (MICAD)- Despite a shorter overall length of hospital stay (9.5 ± 8.7 days vs. 12.3 ± 10.5 days, p < 0.01) with a significantly shorter duration of high care monitoring (intensive/intermediate care or chest pain units) (2.4 ± 2.1 days vs. 4.7 ± 3.3 days, p < 0.01) MINOCA patients consumed a relevant contingent of hospital resources. Thus, in a 12-months period a total sum of almost 300 days was attributed to high care monitoring for MINOCA patients with a mean difference of approximately 50% compared to patients with classical myocardial infarction. With average and median costs of 50% less per index, MINOCA treatment costs were lower compared to the MICAD group in the hospital reimbursement system of Germany. Consequently, MINOCA treatment was not associated with a relevant profit for these expanses and a relevant share of nearly 40% of the total costs was generated due to high care monitoring.

          Conclusion

          In light of lower mortality than MICAD and growing scarcity of staff, financial and capacity resources the clinical symptom complex of MINOCA should be put under particular consideration for refining care concepts and resource allocation.

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          Most cited references33

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          2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

          Héctor Bueno, Borja Ibanez, Stefan James … (2017)
          Article 0 comments Cited 2634 times – based on 0 reviews     Review now
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            (2020)
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              Fourth Universal Definition of Myocardial Infarction (2018)

              Kristian Thygesen, Joseph Alpert, Allan S. Jaffe … (2018)
              Article 0 comments Cited 1240 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Franz Haertel: URI : https://loop.frontiersin.org/people/2600829/overviewRole: Role: Role: Role: Role: Role: Role:
                Carolin Montag: Role: Role:
                Thomas Kraeplin: Role: Role:
                Bernward Lauer: Role:
                Nedim Memisevic: Role: Role:
                Sven Moebius-Winkler: Role:
                P. Christian Schulze: URI : https://loop.frontiersin.org/people/1359941/overviewRole: Role:
                Sylvia Otto: Role: Role: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Public Health
                Journal ID (iso-abbrev): Front Public Health
                Journal ID (publisher-id): Front. Public Health
                Title: Frontiers in Public Health
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-2565
                Publication date (Electronic): 02 October 2024
                Publication date Collection: 2024
                Volume: 12
                Electronic Location Identifier: 1407568
                Affiliations
                [1] 1Klinik für Innere Medizin I, Kardiologie, Universitaetsklinikum Jena , Jena, Germany
                [2] 2Herz - und Gefäßpraxis Gera , Gera, Germany
                Author notes

                Edited by: Xiaozhen Lai, Peking University, China

                Reviewed by: Eduardo Fernandez, University of Salamanca, Spain

                Sivabaskari Pasupathy, University of Adelaide, Australia

                *Correspondence: Franz Haertel, Franz.Haertel@ 123456med.uni-jena.de
                Article
                DOI: 10.3389/fpubh.2024.1407568
                PMC ID: 11480025
                PubMed ID: 39416941
                SO-VID: 983de4bf-d68d-473e-95ab-e1a47f6b5243
                Copyright © Copyright © 2024 Haertel, Montag, Kraeplin, Lauer, Memisevic, Moebius-Winkler, Schulze and Otto.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 26 March 2024
                Date accepted : 27 August 2024
                Page count
                Figures: 4, Tables: 1, Equations: 0, References: 33, Pages: 11, Words: 7371
                Funding
                The author(s) declare financial support was received for the research and authorship. For publication, the author(s) acknowledge support by the German Research Foundation (Project-Nr. 512648189), the open access publication fund of the Thueringer Universitaets - und Landesbibliothek Jena and the publication fund of the Thueringer Universitaets - und Landesbibliothek Jena.
                Categories
                Subject: Public Health
                Subject: Original Research
                Custom metadata
                section-at-acceptance Health Economics

                Keywords: minoca,hospital resources,acs,high care monitoring,intensive care,intermediate care
                Data availability:
                Keywords: minoca, hospital resources, acs, high care monitoring, intensive care, intermediate care

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