Why the study?
Although patients with MINOCA have a more favourable prognosis than those with MI-CAD, their prognosis is worse than the general population, motivating an evaluation of the prognostic value of MINOCA compared with a Southern European population without apparent CAD.
Cohort (n=1,524)
No
Patients with MINOCA have an approximately five-fold higher long-term risk of adverse cardiovascular events and markedly lower 15-year event-free survival compared to individuals without apparent CAD, underscoring the need for sustained secondary prevention.
MINOCA signals higher long-term CV risk than non-CAD controls; extends observational data on adverse prognosis.
Background Some studies showed that the prognosis for patients with Myocardial Infarction (MI) with Non-Obstructive Coronary Artery Disease (MINOCA) is more favourable compared to those with Obstructive Coronary Artery Disease (MI-CAD). However, it has been proven to be worse than the general population. Objective Evaluate the prognostic value of MINOCA compared with a general population without apparent CAD from a Southern European population. Methods A single-centre, prospective, and observational cohort study was performed from January 2000 to December 2023 with a total of 1,524 individuals. Patients were considered MINOCA if their coronary angiogram was classified as zero by the Leaman score. All participants underwent clinical observation, completed a survey form including demographic and traditional risk factors, and underwent biochemical analysis. The primary outcome was all-cause cardiovascular (CV) events [MI, revascularisation, heart failure, stroke, peripheral arterial disease (PAD) and death]. Cox regression analysis identified variables independently associated with CV events and assessed the risk (HR) in these populations. The Kaplan-Meier estimated event-free survival over time. Results Of the 1,524 participants, 87 (5.7%) had MINOCA and 1,437 (94.3%) were normal individuals without symptomatic CAD. Among the 87 MINOCA patients, 14 (16.1%) had CV events, vs 108 (7.5%) in the normal group. The Kaplan-Meier analysis indicated that patients with MINOCA had a lower event-free probability throughout the follow-up period. Specifically, at the end of 15 years, the event-free probability was 52.2% in MINOCA vs 88.7% in the normal group. After Cox regression analysis, the risk of CV for patients with MINOCA was approximately 5 times higher compared with the normal group (p<0.0001). The other variables identified as independently associated with CV events were male sex (p=0.018), age (p<0.0001), smoking (p=0.001), and hypertension (p=0.001). Conclusion In this prospective cohort, patients with MINOCA had a substantially higher long-term risk of CV events than individuals without CAD. Event-free survival was markedly reduced, and MINOCA remained a strong independent predictor of adverse CV outcomes. These findings reinforce that MINOCA is not a benign condition and highlight the need for rigorous risk stratification and sustained secondary prevention in this population.MINOCA vs controls
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Ferreira et al. (2026) conducted a cohort in Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) (n=1,524). Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) vs. Normal individuals without apparent/symptomatic CAD was evaluated on All-cause cardiovascular (CV) events (MI, revascularisation, heart failure, stroke, peripheral arterial disease, and death) (HR ~5, p=<0.0001).
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