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Coronary artery disease
Original research article
Outcome after myocardial infarction without obstructive coronary artery disease
  1. Michael J A Williams1,
  2. Peter R Barr2,
  3. Mildred Lee2,3,
  4. Katrina K Poppe3,
  5. Andrew J Kerr2,3
  1. 1 Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  2. 2 Cardiology Department, Counties Manukau District Health Board, Auckland, New Zealand
  3. 3 Epidemiology and Biostatistics Section, University of Auckland, Auckland, New Zealand
  1. Correspondence to Professor Michael J A Williams, Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin 9054, New Zealand; michael.williams{at}otago.ac.nz

Abstract

Objective The medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).

Methods We performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome—Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.

Results Of the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.

Conclusions MINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.

  • coronary artery disease
  • acute coronary syndromes
  • cardiac catheterization and angiography
  • acute myocardial infarction

https://doi.org/10.1136/heartjnl-2018-313665

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    Footnotes

    • Contributors MJAW, PRB and AJK: Study concept, design and implementation. ML and KKP: Analyses and model construction. MJAW and AJK: Manuscript drafting. All authors: critical revision of the manuscript for important intellectual content and approval of the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The VIEW and PREDICT programmes were developed and are maintained by the VIEW team in the Section of Epidemiology and Biostatistics at the University of Auckland. The ANZACS-QI and PREDICT software were developed and supported by Enigma Solutions. AJK and KKP have support from the Health Research Council of New Zealand for the submitted work.

    • Patient consent Not required.

    • Ethics approval Northern Region Ethics Committee Y (AKY/03/12/314) and national Multi-Region Ethics Committee (MEC/01/19/EXP).

    • Provenance and peer review Not commissioned; externally peer reviewed.

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