Affiliation:
1. Division of Cardiology Department of Cardiology The Catholic University of Korea Seoul Korea
2. Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju South Korea
3. Department of Cardiology Yeungnam University Medical Center Daegu South Korea
4. Department of Internal Medicine Kyungpook National University Hospital Daegu South Korea
5. Cardiology Division Department of Internal Medicine Chungbuk National University Hospital Cheongju South Korea
6. Department of Internal Medicine Kyunghee University College of Medicine Seoul South Korea
7. Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul South Korea
Abstract
Background
Myocardial infarction with nonobstructive coronary arteries (
MINOCA
) is a heterogeneous disease entity. Its prognosis and predictor of mortality remain unclear. This study aimed to compare the prognosis between
MINOCA
and myocardial infarction with obstructive coronary artery disease and identify factors related to all‐cause death in
MINOCA
using a nation‐wide, multicenter, and prospective registry.
Methods and Results
Among 13 104 consecutive patients enrolled, patients without previous history of significant coronary artery disease who underwent coronary angiography were selected. The primary outcome was 2‐year all‐cause death. Secondary outcomes were cardiac death, noncardiac death, reinfarction, and repeat revascularization. Patients with
MINOCA
(n=396) and myocardial infarction with obstructive coronary artery disease (n=10 871) showed similar incidence of all‐cause death (9.1% versus 8.8%; hazard ratio [
HR
], 1.04; 95% CI, 0.74–1.45;
P
=0.83). Risks of cardiac death, noncardiac death, and reinfarction were not significantly different between the 2 groups (
HR
, 0.82; 95%
CI
, 0.53–1.28;
P
=0.38;
HR
, 1.55; 95%
CI
, 0.93–2.56;
P
=0.09;
HR
, 1.23; 95%
CI
, 0.65–2.31;
P
=0.38, respectively).
MINOCA
patients had lower incidence of repeat revascularization (1.3% versus 7.2%;
HR
, 0.17; 95%
CI
, 0.07–0.41;
P
<0.001). Results were consistent after multivariable regression and propensity‐score matching. In a multivariate model, several significant predictors of all‐cause death of
MINOCA
were found, including the nonuse of renin‐angiotensin system blockers (
HR
, 2.63; 95%
CI
, 1.08–6.25;
P
=0.033) and statins (
HR
, 2.17; 95%
CI
, 1.04–4.54;
P
=0.039).
Conclusions
Patients with
MINOCA
and those with myocardial infarction with obstructive coronary artery disease had comparable clinical outcomes. Use of renin‐angiotensin system blockers and statins was associated with lower mortality in patients with
MINOCA
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
105 articles.
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