Myocardial Infarction with No -Obstructive Coronary Artery Disease (MINOCA) - Israel Experience. A Long Term Follow-up

Background: Patients with myocardial infarction (MI) and no obstructive coronary artery disease (CAD), now termed MINOCA, are increasingly seen. We aimed to characterize MINOCA patients included Acute Coronary Syndrome Israeli Survey (ACSIS) and their outcome.

Methods: We used patients data collected from ACSIS from 2000 to 2016. MINOCA was defined as the group of patients without prior CAD and no obstructive CAD on angiography. OCAD represents the groups of patients with obstructive CAD. The 2 groups were compared at baseline. Rates of 30 days MACE defined as death, unstable angina, myocardial infarction, stroke, stent thrombosis or urgent revascularization were compared as also 1 and 10 years survival rates. A separate analysis was conducted for sex differences.

Results: Among 15.211 MI patients, 5553 had no prior CAD. Among these, 5297 (95.4%) had OCAD and 256 (4.6%) had MINOCA. MINOCA patients were younger (57y±13 vs 61±12y, p<0.001). Percentage of women was significantly higher within MINOCA as compared to OCAD (41 % vs 22 %, respectively, p<0.001). There was no difference in cardiovascular risk factors among the 2 groups. MINOCA patients had less discharge medication. Strong predictors of MINOCA were female sex (OR 4.22) and prior COPD (OR 3.28). Rates of 30 days MACE were 2.3% in MINOCA vs 10.4% in OCAD patients (p<0.001). MINOCA patients had better 1 and 10 years survival rates (p=0.013 and p=0.006, respectively). When analyzed by sex, 1 year and 10 years survival rates were similar in women and men with MINOCA (p=0.17 and p=0.10, respectively) while lower survival rates were seen in women with OCAD as compared to men (Figure).

Conclusions: MINOCA patients have similar risk factors as OCAD but tend to receive less guideline recommended therapy. The sex differences in short and long term outcome seen in patients with OCAD were not seen in MINOCA patients.