Key result
First-time MINOCA was associated with a higher risk of major adverse events compared to non-MI controls (21.5% vs 6.6%; HR 2.12, 95% CI 1.84-2.43).
Why the study?
Data were limited regarding long-term cardiovascular morbidity and cause-specific mortality in patients with MINOCA.
Does first-time MINOCA increase the risk of major adverse events compared to non-MI controls and MI-CAD?
Cohort (n=80,602)
Yes
Does first-time MINOCA increase the risk of major adverse events compared to non-MI controls and MI-CAD?
Hazard Ratio: 2.12 (95% CI 1.84–2.43)
Absolute Event Rate: 21.5% vs 6.6%
Patients with first-time MINOCA have a significantly higher risk of major adverse events compared to non-MI controls, highlighting the need for comprehensive evaluation and close follow-up.
MINOCA patients face substantial long-term risk; leaves open optimal secondary prevention strategies pending randomized trials.
BACKGROUND: Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is receiving increasing interest as a prognostically adverse entity distinct from myocardial infarction with significant coronary artery disease (MI-CAD). However, data are still limited regarding long-term cardiovascular morbidity and cause-specific mortality in MINOCA. METHODS: This is a registry-based cohort study using data from patients admitted to Swedish coronary care units. We investigated various nonfatal outcomes (recurrent MI, hospitalization for heart failure or stroke) and fatal outcomes (cardiovascular, respiratory or cancer-related mortality) in 4069 patients without apparent acute cardiovascular disease, used as non-MI controls, 7266 patients with first-time MINOCA and 69 267 patients with first-time MI-CAD. RESULTS: Almost all event rates (median follow-up 3.8 years) increased in a stepwise fashion across the three cohorts [rates of major adverse events (MAE; composite of all-cause mortality, recurrent MI, hospitalization for heart failure or stroke): n = 268 (6.6%), n = 1563 (21.5%), n = 17 777 (25.7%), respectively]. Compared to non-MI controls, MINOCA patients had an adjusted hazard ratio (HR) of 2.12 (95% confidence interval 1.84-2.43) regarding MAE. MINOCA patients had a substantial risk of cardiovascular mortality and the highest numerical risks of respiratory and cancer-related mortality. Male sex, previous heart failure and chronic obstructive pulmonary disease had a stronger prognostic impact in MINOCA than in MI-CAD. Female MINOCA patients with atrial fibrillation were at particular risk. CONCLUSIONS: Patients with first-time MINOCA have a considerable risk of adverse events. This stresses the need for a comprehensive search of the cause of MINOCA, thorough treatment of underlying disease triggers and close follow-up.
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Eggers et al. (2018) conducted a cohort in Myocardial infarction with nonobstructive coronary arteries (MINOCA) (n=80,602). First-time MINOCA vs. Non-MI controls was evaluated on Major adverse events (composite of all-cause mortality, recurrent MI, hospitalization for heart failure or stroke) (HR 2.12, 95% CI 1.84-2.43). First-time MINOCA was associated with a higher risk of major adverse events compared to non-MI controls (21.5% vs 6.6%; HR 2.12, 95% CI 1.84-2.43).
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