Long-Term Outcome of Patients with Myocardial Infraction with Nonobstructive Coronary Arteries - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Eed Abu-Zaid ^1,3 Omri Edry Nadiv ^1,3 Ido Peles ^2,4 Yigal Abramowitz ^1,3 Carlos Cafri ^1,3 Gabriel Rosenstein ^1,3 Miri Merkin ^1,3 Doron Zahger ^1,3 Edward Koifman ^1,3

¹Cardiology, Soroka University Medical Center and Ben-Gurion University of The Negev, Beer Sheva, Israel, Israel
²Clinical research center, Soroka Medical Center, Ben-Gurion University of The Negev, Beer Sheva, Israel
³Cardiology, Soroka University Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel, Israel
⁴Clinical research center, Soroka University Medical Center, Ben-Gurion University of The Negev, Israel

Background

Myocardial infarction with nonobstructive coronary arteries (MINOCA) is a condition of growing interest and research. We aimed to evaluate the long-term prognosis of MINOCA patients and identify possible risk factors associated with long term mortality in this patient`s population.

Methods

We performed a retrospective observational cohort study including all patients aged ≥18 years hospitalized to a large tertiary center between 2005-2018 with a primary diagnosis of acute myocardial infarction (AMI) and non-obstructive lesions with less than <50% stenosis in all coronary arteries. The aim of the study was to assess the long-term mortality and to evaluate factors associated with increased mortality in this population.

Results

MINOCA was diagnosed in 1544 patients during the study period. Mean age of patients was 61± 12.3 and 46% were female. Common comorbidities were dyslipidemia (32.6%) and hypertension (21.2%) and 17% had prior PCI. More than third of the patients were treated with statins (37.2%), micropirin (32.7%) and angiotensin converting enzyme (ACE)-inhibitors (30.4%). While short-term prognosis was favorable with only 1.2% mortality at 30-days, 1-year mortality was 3.9% and 19.9% mortality at mean follow-up time of 8.5 years. While many factors were associated with unfavorable long-term outcome in the univariate analysis, only advanced age (HR =1.05, 95% confidence interval (CI) 1.02-1.07; p<0.001) and congestive heart failure (HR=3.53, 95%CI 1.74-7.18; P<0.001) were independently associated with increased mortality risk in the adjusted model.

Conclusions

MINOCA is not an infrequent condition that carries a good short-term outcome, but long-term outcome may be comparable to patients with obstructive coronary disease. Further research should be performed to elucidate the various mechanisms of MINOCA.