OBJECTIVES: The aim of this study was to determine the prevalence of myocarditis among patients presenting with myocardial infarction with nonobstructive coronary arteries (MINOCA) in relation to the angiographic severity of nonobstructive coronary artery disease (CAD). BACKGROUND: MINOCA represents about 6% of all cases of acute myocardial infarction. Myocarditis is a diagnosis that may be identified by cardiac magnetic resonance (CMR) imaging in patients with a provisional diagnosis of MINOCA. METHODS: A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients with nonobstructive CAD or normal coronary arteries. Study-level and individual patient data meta-analyses were performed using fixed- and random-effects methods. RESULTS: Twenty-seven papers were included, with 2,921 patients with MINOCA; CMR findings were reported in 2,866 (98.1%). Myocarditis prevalence was 34.5% (95% confidence interval [CI]: 27.2% to 42.2%) overall and was numerically higher in studies that defined MINOCA as myocardial infarction with angiographically normal coronary arteries compared with a definition that permitted nonobstructive CAD (45.9% vs. 32.3%; p = 0.16). In a meta-analysis of individual patient data from 9 of the 27 studies, the pooled prevalence of CMR-confirmed myocarditis was greater in patients with angiographically normal coronary arteries than in those with nonobstructive CAD (51% [95% CI: 47% to 56%] vs. 23% [95% CI: 18% to 27%]; p < 0.001). Men and younger patients with MINOCA were more likely to have myocarditis. Angiographically normal coronary arteries were associated with increased odds of myocarditis after adjustment for age and sex (adjusted odds ratio: 2.30; 95% CI: 1.12 to 4.71; p = 0.023). CONCLUSIONS: Patients with a provisional diagnosis of MINOCA are more likely to have CMR findings consistent with myocarditis if they have angiographically normal coronary arteries.

1st Department of Internal Medicine Cardioangiology and International Clinical Research Center St Anne's Faculty Hospital Faculty of Medicine Masaryk University Brno Czech Republic

Cardiac Department Vannini Hospital Rome Rome Italy

Cardiology Intensive Care Unit and Interventional Cardiology Hôpital Cardiologique du Haut Lévêque Pessac France; Bordeaux Cardio Thoracic Research Centre U1045 Bordeaux University Bordeaux France

Department of Cardiology Centro Hospitalar de Leiria Leiria Portugal

Department of Cardiovascular Medicine Flinders University of South Australia Adelaide Australia

Department of Diagnostic and Interventional Radiology University Medical Center Johannes Gutenberg University Mainz Mainz Germany; German Center for Cardiovascular Research partner site Rhine Main University Medical Center Johannes Gutenberg University Mainz Germany

Department of Medicine New York University School of Medicine New York New York

Department of Population Health New York University School of Medicine New York New York

Health Sciences Library New York University School of Medicine New York New York

Houston Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital Houston Texas

Institut MITOVASC Remodelage et Thrombose Service de Cardiologie CHU d'Angers Angers France

Soter Center for Women's Cardiovascular Research Leon H Charney Division of Cardiology Department of Medicine New York University School of Medicine New York New York

JACC Cardiovasc Imaging. 2020 Sep;13(9):1914-1916. doi: 10.1016/j.jcmg.2020.07.002. PubMed

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