Predictors of poor clinical outcomes in patients with acute myocardial infarction and non-obstructed coronary arteries (MINOCA)

Abstract Objective To assess the characteristics and prognosis of patients with myocardial infarction and non-obstructed coronary arteries (MINOCA). Methods MINOCA was defined as acute myocardial infarction (AMI) with angiographic coronary stenosis Results From January 2006 to December 2014, 7935 consecutive AMI patients were entered into our institutional database;150 (2%) were diagnosed as having MINOCA. At a median follow-up of 7.1 years the composite end-point (cardiovascular death, AMI or acute coronary syndrome, heart failure, stroke) occurred in 23 patients (17.4%). Survival analysis showed no differences between NCA versus MCAD ( p  = 0.781). When assessed by distribution of CAD, group III had a lower event-free survival compared to group I and group II, respectively 54 ± 14%, 83 ± 4% and 90 ± 5% ( p  = 0.001). In a multivariate model, only 3 vessel disease or LMS involvement (HR = 23.5, 95% CI 2.59–173.49, P  = 0.001) and high C-reactive protein at hospital admission (HR = 1.47, 95% CI 1.06–2.07, P  = 0.005) were significant predictors of the study composite endpoint. Conclusions In patients with MINOCA, the presence of NCA or 1–2 vessel MCAD was associated with better long-term clinical outcomes compared with patients with MCAD affecting 3 vessels or the LMS. Increased CRP concentrations on hospital admission were also a marker of worse clinical outcome during follow-up.