Association of common risk factors with major adverse cardiac events and mortality in patients with MINOCA: A systematic review and meta-analysis

BACKGROUND Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous condition with variable outcomes. The prognostic value of common clinical risk factors for major adverse cardiac events (MACEs) and all-cause mortality remains unclear. This study systematically evaluates associations between traditional risk factors and adverse outcomes in MINOCA. METHODS A systematic review and meta-analysis was conducted to assess pooled hazard ratios (HRs) for clinical variables associated with MACEs and all-cause mortality. Eligible studies reporting HRs with at least 6 months of follow-up were included. Random-effects models were used to derive pooled estimates. RESULTS Eleven studies including 12,081 patients were analyzed. Over a mean follow-up of 49.2 months, pooled MACEs incidence was 17% (95% CI: 11-26%) and all-cause mortality was 10% (95% CI: 8-14%). Older age increased the risk of MACEs (HR: 1.02; 95% CI: 1.01-1.04), while higher BMI was protective (HR: 0.92; 95% CI: 0.86-0.99). For all-cause mortality, significant predictors included age (HR: 1.04 per year), diabetes (HR: 1.33; 95% CI: 1.07-1.64), creatinine (HR: 1.01; 95% CI: 1.0009-1.02), and STEMI-pattern presentation (HR: 2.85; 95% CI: 1.09-7.44). Higher BMI (HR: 0.89; 95% CI: 0.82-0.98) and dyslipidemia (HR: 0.83; 95% CI: 0.76-0.90) were associated with lower mortality. CONCLUSION Only select clinical variables predict outcomes in MINOCA, while many traditional MI risk factors do not. These findings highlight the need for MINOCA-specific risk models and targeted management strategies.