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Morbidity and cause‐specific mortality in first‐time myocardial infarction with nonobstructive coronary arteries
Author(s) -
Eggers K. M.,
Hjort M.,
Baron T.,
Jernberg T.,
Nordenskjöld A. M.,
Tornvall P.,
Lindahl B.
Publication year - 2019
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1111/joim.12857
Subject(s) - medicine , myocardial infarction , cardiology , heart failure , hazard ratio , stroke (engine) , coronary artery disease , atrial fibrillation , proportional hazards model , cohort , confidence interval , engineering , mechanical engineering
Background Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is receiving increasing interest as a prognostically adverse entity distinct from myocardial infarction with significant coronary artery disease (MI‐CAD). However, data are still limited regarding long‐term cardiovascular morbidity and cause‐specific mortality in MINOCA. Methods This is a registry‐based cohort study using data from patients admitted to Swedish coronary care units. We investigated various nonfatal outcomes (recurrent MI, hospitalization for heart failure or stroke) and fatal outcomes (cardiovascular, respiratory or cancer‐related mortality) in 4069 patients without apparent acute cardiovascular disease, used as non‐MI controls, 7266 patients with first‐time MINOCA and 69 267 patients with first‐time MI‐CAD. Results Almost all event rates (median follow‐up 3.8 years) increased in a stepwise fashion across the three cohorts [rates of major adverse events (MAE; composite of all‐cause mortality, recurrent MI, hospitalization for heart failure or stroke): n = 268 (6.6%), n = 1563 (21.5%), n = 17 777 (25.7%), respectively]. Compared to non‐MI controls, MINOCA patients had an adjusted hazard ratio (HR) of 2.12 (95% confidence interval 1.84–2.43) regarding MAE. MINOCA patients had a substantial risk of cardiovascular mortality and the highest numerical risks of respiratory and cancer‐related mortality. Male sex, previous heart failure and chronic obstructive pulmonary disease had a stronger prognostic impact in MINOCA than in MI‐CAD. Female MINOCA patients with atrial fibrillation were at particular risk. Conclusions Patients with first‐time MINOCA have a considerable risk of adverse events. This stresses the need for a comprehensive search of the cause of MINOCA, thorough treatment of underlying disease triggers and close follow‐up.