Left Ventricular Aneurysm after MINOCA in Antiphospholipid Syndrome: A Single-Center Cohort Study

Introduction

Antiphospholipid syndrome (APS) is a rare thrombophilia. Myocardial infarction (MI) in APS often occurs via MINOCA (myocardial infarction with non-obstructive coronary arteries). Left ventricular aneurysm (LVA) is a severe complication reported only anecdotally. Its incidence, predictors, and outcomes remain unknown.

Methods

We conducted a retrospective cohort study (2005–2025) at a tertiary cardiovascular center, including patients with definite APS and acute MI meeting MINOCA criteria: angiographic stenosis <50% in coronary vessels and no other identifiable non-ischemic cause. LVA was defined by echocardiography as a thin-walled, dyskinetic segment with a neck. The primary outcome was incidence of LVA; secondary outcomes included recurrent thrombosis, hospitalization, and mortality.

Results

Among 62 APS patients with acute MI, 48 (77%) met MINOCA criteria. LVA developed in 13 of 48 MINOCA patients (27.1%), versus 11 of 144 (7.6%) randomly selected patients with obstructive coronary disease (p=0.03). Predictors of LVA in APS patients included triple-antibody positivity (92% vs. 57%, p=0.02), anterior MI location (100% vs. 51%, p=0.002), peak troponin I>60 ng/mL (p<0.001), and delayed presentation >12 hours (77% vs. 34%, p=0.01). At median follow-up of 3.5 years, LVA after surgical treatment was associated with higher rates of recurrent arterial thrombosis (46% vs. 17%, HR 3.5, 95% CI 1.6–7.8, p=0.002) and hospitalization (54% vs. 11%, p<0.001). All-cause mortality was 33% in the LVA group (5-year survival endpoint).

Conclusions

MINOCA is the predominant MI mechanism in APS. Post-infarction LVA occurs in over one in four APS patients with MINOCA. Triple positivity, anterior MI, and delayed presentation are key risk factors. LVA plus APS confers markedly increased risks of recurrent thrombosis and mortality.