Mental disorders, psychotropic drug dispensation and unfavourable sociodemographic factors in patients with myocardial infarction with and without obstructive coronary arteries

Knowledge on the influence of mental disorders and unfavourable sociodemographic factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) remains limited. We investigated the prevalence of mental disorders, psychotropic drug dispensation, and sociodemographic factors in patients with MINOCA and MI with coronary artery disease (MI-CAD) and assessed their association with prognosis. In this nationwide register-based cohort study of 8,367 MINOCA and 109,059 MI-CAD patients, mental disorders (4.3% vs 2.6%, p<0.001) and psychotropic drug dispensation (26.1% vs 17.4%, p<0.001) were more frequent in MINOCA, particularly female patients. MINOCA patients were also more often 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). Over a median 5.5-year follow-up, a major adverse cardiovascular event (MACE) occurred in 25.5% of MINOCA and 27.8% of MI-CAD patients (p<0.001). Adjusted analyses showed that mental disorders and dispensed psychotropic drug independently predicted MACE in both MINOCA (HR 1.27; 95% CI 1.15-1.40) and MI-CAD (HR 1.35; 95% CI 1.31-1.39). Mental disorders and psychotropic drug dispensation were more common in MINOCA than MI-CAD, particularly in female patients. Unfavourable sociodemographic factors were more common in both groups, with a modest excess in MINOCA. The association between mental health variables and adverse outcomes in both conditions suggests shared mechanisms beyond traditional cardiovascular risk factors. • Mental disorders and psychotropic drug dispensation are more prevalent during the six months prior MI in patients with MINOCA compared to MI-CAD. • Unfavourable sociodemographic factors are more common in patients with MINOCA compared to MI-CAD at the time of MI. • Mental disorders and psychotropic drug dispensation are independently associated with increased risk of major cardiovascular events during follow-up in both groups. • Present and prior mental health conditions should be given greater consideration in the management of patients with myocardial infarction, particularly those with MINOCA, as they have a significant impact on prognosis.