CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 4, September/October 2023 206 AFRICA Atrial and ventricular arrhythmia predictors with electrocardiographic parameters in myocardial infarction with non-obstructive coronary artery disease (MINOCA) Serkan Asil, Muhammet Geneş, Salim Yaşar, Serdar Fırtına, Suat Görmel, Erkan Yıldırım, Yalçın Gökoğlan, Hatice Tolunay, Barış Buğan, Ayşe Saatçi Yaşar, Murat Çelik, Uygar Çağdaş Yüksel, Cem Barçın, Hasan Kutsi Kabul Abstract Background: The clinical importance and recognition of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is increasing. Nevertheless, no studies are investigating the risk of atrial fibrillation and ventricular arrhythmia in MINOCA patients. This study aimed to determine the risk of arrhythmia with electrocardiographic predictors in MINOCA patients. Methods: In this study, patients diagnosed with MINOCA and stable out-patients without significant lesions in their coronary arteries were compared. Morphology–voltage–P‐ wave duration electrocardiography (MPV ECG) score was used to determine atrial arrhythmia risk. QT interval and QT dispersion Tpeak–Tend time and Tpeak–Tend/QT interval were used to determine ventricular arrhythmia risk. Results: A total of 155 patients were included in our study. Seventy-seven of these patients were in the MINOCA group. There was no statistically significant difference between the two groups in MPV ECG score (1.95 ± 1.03 vs 1.68 ± 1.14, p = 0.128). P-wave voltage, P-wave morphology and P-wave duration, which are components of the MPV ECG score, were not statistically significantly different. The QRS complex duration (90.21 ± 14.87 vs 82.99 ± 21.59 ms, p = 0.017), ST interval (271.95 ± 45.91 vs 302.31 ± 38.40 ms, p < 0.001), corrected QT interval (438.17 ± 43.80 vs 421.41 ± 28.39, p = 0.005) and QT dispersion (60.75 ± 22.77 vs 34.19 ± 12.95, p < 0.001) were statistically significantly higher in the MINOCA group. The Tpeak–Tend (89.53 ± 32.16 vs 65.22 ± 18.11, p < 0.001), Tpeak–Tend/QT interval (0.2306 ± 0.0813 vs 0.1676 ± 0.0470, p < 0.001) and Tpeak–Tend/corrected QT interval (0.2043 ± 0.6997 vs 0.1551 ± 0.4310, p < 0.001) ratios were also significantly higher in patients with MINOCA. Conclusion: In the MINOCA patients, there was no increase in the risk of atrial fibrillation based on ECG predictors. However, it was shown that there could be a significant increase in the risk of ventricular arrhythmia. We believe this study could be helpful for specific recommendations concerning duration of hospitalisation and follow up in MINOCA patients. Keywords: arrhythmia, atrial fibrillation, electrocardiography, MINOCA, ventricular tachycardia Submitted 14/7/22; accepted 15/8/22 Published online 8/9/22 Cardiovasc J Afr 2023; 34: 206–211 www.cvja.co.za DOI: 10.5830/CVJA-2022-045 Myocardial infarction with non-obstructive coronary arteries (MINOCA) describes patients presenting with clinical features of an acute myocardial infarct (MI) without obstructive coronary artery disease (CAD).1,2 The primary determinant of the clinic for MINOCA is ischaemic CAD without an obvious over-50% obstruction in the coronary arteries.1 Furthermore, the reason for elevation of non-ischaemic cardiac enzymes must be excluded. The pathophysiology of MINOCA is multifactorial and similar to atherosclerosis risk factors.1 Atherosclerotic plaque disruption is the most common underlying cause in intravascular coronary imaging-based and angiographic-based studies.3,4 Other possible underlying causes are coronary vasospasm, microvascular dysfunction, coronary thrombus-embolism, spontaneous coronary dissections and myocardial oxygen supply/demand mismatch.1 The underlying cause determines the prognosis of patients with MINOCA. Most research suggests that MINOCA patients had better outcomes than patients with MI with obstructed CAD.5 However, this conclusion is not shared by all researchers. Furthermore, some of them reported that MINOCA patients have an increased risk of future adverse events such as MI with obstructive CAD.6,7 While the arrhythmic prognosis of patients with MI with obstructive CAD is well documented, there is little data concerning MINOCA, even when the arrhythmic prognosis seems to be relatively good. Because of the underlying pathophysiological mechanism, an increased risk of atrial and ventricular arrhythmias may be predicted in MINOCA patients. However, the number of studies showing an increase in arrhythmia in the literature is quite limited. Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Turkey Serkan Asil, MD, dr_serkanasil@hotmail.com Muhammet Geneş, MD Salim Yaşar, MD Serdar Fırtına, MD Suat Görmel, MD Erkan Yıldırım, MD Yalçın Gökoğlan, MD Hatice Tolunay, MD Barış Buğan, MD Ayşe Saatçi Yaşar, MD Murat Çelik, MD Uygar Çağdaş Yüksel, MD Cem Barçın, MD Hasan Kutsi Kabul, MD
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