Key result
Psychiatric diagnoses or medications link to ~30% higher MACE risk in MINOCA and MI-CAD.
Why the study?
The impact of psychiatric disorders and psychosocial factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) is unknown.
Are psychiatric diagnoses and negative psychosocial factors associated with adverse cardiovascular outcomes in patients with MINOCA and MI-CAD?
Cohort (n=117,426)
Yes
Are psychiatric diagnoses and negative psychosocial factors associated with adverse cardiovascular outcomes in patients with MINOCA and MI-CAD?
Absolute Event Rate: 31.8% vs 33.2%
p-value: p=<0.001
Psychiatric diagnoses and negative psychosocial factors are more prevalent in MINOCA than MI-CAD and are independently associated with an increased risk of MACE in both patient populations.
Psychiatric factors warrant consideration in post-MI risk assessment; supports further study of integrated interventions in both MINOCA and MI-CAD.
Background and purpose The impact of psychiatric disorders and psychosocial factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) is unknown. We investigated the prevalence of psychiatric diagnoses, the use of medications affecting the nervous system, and negative psychosocial factors in patients experiencing MINOCA and MI with coronary artery disease (MI-CAD), and assessed their association with prognosis. Method Nationwide descriptive cohort study based on data collected from the SWEDEHEART registry, census data from Statistics Sweden and three mandatory Swedish population-based national registries: Prescribed Drug Register, the Patient Register, and the Cause-of-death Register. Results A total of 8,367 MINOCA and 109,059 MI-CAD patients were included. In the six months prior to MI, MINOCA patients showed a significantly higher rate of psychiatric diagnoses (4.3% vs 2.6%, p<0.001) and a greater rate of dispensed medication acting on the nervous system (32.1% vs 22.9%, p<0.001) compared to MI-CAD. At the time of MI, MINOCA patients were significantly more likely to be divorced (21.1% vs 19.7%, p<0.001), widowed (6.8% vs 4.9%, p<0.001), or on sick leave (4.4% vs 3.2%, p<0.001) than MI-CAD. Over the course of a median follow-up of 5.5 years, 31.8% of MINOCA and 33.2% of MI-CAD patients experienced a major adverse cardiovascular event (MACE) (p<0.001). In multivariable analyses adjusted for traditional risk factors, psychiatric diagnosis or a dispensed drug acting on the nervous system were independently associated with MACE in both MINOCA (HR 1.30; 95% CI 1.17–1.38) and MI-CAD (HR 1.33; 95% CI 1.30–1.36). Conclusion The prevalence of psychiatric diagnoses, dispensed drugs acting on the nervous system, and negative psychosocial factors was greater in patients with MINOCA than with MI-CAD. The association of these factors with adverse outcomes in both MINOCA and MI-CAD may indicate a common underlying mechanism beyond traditional cardiovascular risk factors.Table
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Nordenskjold et al. (2025) conducted a cohort in Myocardial infarction with non-obstructive coronary arteries (MINOCA) and MI with coronary artery disease (MI-CAD) (n=117,426). MINOCA vs. MI-CAD was evaluated on major adverse cardiovascular event (MACE) (p=<0.001). Psychiatric diagnoses or dispensed drugs acting on the nervous system were independently associated with MACE in both MINOCA (HR 1.30; 95% CI 1.17-1.38) and MI-CAD (HR 1.33; 95% CI 1.30-1.36).
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