HARP-MINOCA Outlines Benefit of OCT, Cardiac CMR When Diagnosing Heart Attacks

Harmony Reynolds, MD

New research from a study of more than 300 women is underlining the potential benefit of combining diagnostic imaging methods when treating women with myocardial infarction with non-obstructive coronary arteries (MINOCA).

Results of the HARP-MINOCA, which were presented at the American Heart Association’s (AHA) Scientific Sessions 2020, suggest use of coronary optical coherence tomography (OCT) and cardiac magnetic resonance imaging (MRI) explained why women presented with symptoms and had blood tests consistent with heart attack in 84% of the study cohort.

“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 lead investigator Harmony Reynolds, MD, 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 a statement from the AHA.

Funded by the AHA, HARP-MINOCA was designed as a prospective, multicenter, international, diagnostic observational study and enrolled women with MI who did not have prior obstructive coronary artery disease (CAD) with the aim of evaluate the mechanisms of MINOCA and to identify cause of the heart attack in these patients. Among 301 women enrolled across 15 sites, investigators determined 168 had MINOCA—the patient population had a median age of 60 years and 50% were non-Hispanic whites.

Patients included in the study underwent multivessel OCT followed by CMR if invasive coronary angiography showed less than 50% stenosis in all major vessels. Investigators noted angiography, OCT, and CMR, were evaluated at blinded, independent core labs.

Check out this AHA 2020 video with John McMurray, MD, examining differences in HFpEF among men and women.​

Of the 168 patients who had MINOCA, 21 had contraindications to OCT. Among the 147 who underwent OCT, 145 had adequate OCT for analysis and 116 underwent CMR (median 6 days from MI; IQR, 3-9).

When using OCT and cardiac MRI data, investigators were able to determine cause for MINOCA in 84% of patients. Imaging data determined 74 experienced myocardial infarction—the other diagnoses included myocarditis (17), Takotsubo Syndrome (n=4), and non-ischemic cardiomyopathy (n=3). OCT imaging tests led to the identification of a definite or possible culprit lesion in 46.7% of women (95% CI, 38.0-54.7%) with OCT imaging data and cardiac CMR was abnormal in 86 of the 116 women with available data (95% CI, 65.0-81.6%).

“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.”

This study, "Coronary Oct And Cardiac Mri To Determine Underlying Causes Of Minoca In Women,” was presented at AHA 2020.