What does this research mean for the field?

First-degree relatives of patients with MINOCA do not have an increased familial risk of MINOCA, but do have an increased risk of MI-CAD, suggesting shared genetic and environmental factors between the two conditions. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

September 29, 2024Open Access

Familial risk of myocardial infarction with non-obstructive and obstructive coronary arteries: a nation-wide cohort study

Structured PICO

Is there an increased familial risk of MINOCA or MI-CAD among first-degree relatives of patients with MINOCA compared to controls?

Population

15,462 MINOCA cases, 204,424 MI-CAD cases, and 38,220 control subjects without MI and with non-obstructive coronary arteries, along with their first-degree relatives identified in 1995-2020.

Intervention

Having a first-degree relative with MINOCA or MI-CAD

Comparator

Having a first-degree relative without MI and with non-obstructive coronary arteries (control subjects)

Outcome

Occurrence of MINOCA or MI-CAD in first-degree relativeshard clinical

First-degree relatives of MINOCA patients do not have an increased risk of MINOCA but do have a slightly increased risk of MI-CAD, suggesting shared underlying mechanisms with CAD.

Abstract

AIMS: The familial risk among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is unknown. Previous studies of family history in myocardial infarction (MI) have not made a distinction between MINOCA and MI due to coronary artery disease (MI-CAD), based on angiographic findings. We therefore sought to investigate familial risk of MI without and with obstructive coronary arteries. METHODS AND RESULTS: Register-based cohort study with a total of 15 462 MINOCA cases, 204 424 MI-CAD cases, 38 220 control subjects without MI, and with non-obstructive coronary arteries. First-degree relatives were identified in 1995-2020. Cox proportional hazard regression models were used to compare familial risk in MINOCA and MI-CAD with control subjects. During a mean follow-up of 8.1 ± 4.2 years, MINOCA occurred in 1.0% of first-degree relatives with MINOCA whereas MI-CAD occurred in 9.7% of first-degree relatives of MINOCA. The age- and sex-adjusted hazard ratio (HR) for a MINOCA relative experiencing MINOCA and MI-CAD, compared to control subjects, was 0.99 95% confidence interval (CI) 0.80-1.23 and 1.10 (95% CI 1.03-1.18), respectively. During a mean follow-up of 8.5 ± 4.8 years, MI-CAD occurred in 12.2% of first-degree relatives with MI-CAD with age- and sex-adjusted HR 1.43 (95% CI 1.37-1.49). CONCLUSION: No increased familial risk of MINOCA was observed for MINOCA patients whereas there was an increased familial risk for MI-CAD when compared to control subjects. These results may indicate that genetic factors and shared environmental factors within a family leading to CAD are important also for MINOCA, thus MI-CAD and MINOCA could share underlying mechanisms.

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