Association of myocardial infarction with nonobstructive coronary arteries with in-hospital outcomes

Abstract

Abstract Background Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) is a disease classification that is not uncommonly encountered yet poorly characterized. The association of MINOCA with in-hospital cardiovascular outcomes has been inconsistently assessed with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of MINOCA with in-hospital cardiovascular outcomes. Methods A literature search was conducted for studies reporting on the association of MINOCA with clinical endpoints as compared to obstructive coronary artery disease (OCAD). The primary end-point was in-hospital mortality. Secondary endpoints included cardiogenic shock (CS) on admission and congestive heart failure (CHF) during hospitalization. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results 19 studies with 851,886 patients who had acute myocardial infarction (AMI) (45,475 patients with MINOCA, 80,6411 with OCAD) met inclusion criteria. Mean age was 63, 64% were male. Patients with MINOCA had significantly lower risk of in-hospital mortality compared to patients with OCAD (OR 0.42, 95% CI 0.31-0.57; p<0.01), the overall effect size was large (z=5.59). Patients with MINOCA had significantly lower risk of having cardiogenic shock on presentation compared to OCAD, however had no difference in risk of developing CHF during hospitalization (OR 0.45, 95% CI 0.35-0.58; p<0.01; OR 0.78, 95% CI 0.55-1.10; p=0.15). Conclusions Our results suggest that MINOCA is associated with lower risk of in-hospital mortality and lower risk of presentation with cardiogenic shock compared to OCAD. However, patients with MINOCA appear to have a similar risk of developing CHF during hospitalization compared to patients with OCAD.