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Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA). 2022
Giulia Magnani, and
Serena Bricoli, and
Maddalena Ardissino, and
Giuseppe Maglietta, and
Adam Nelson, and
Guidantonio Malagoli Tagliazucchi, and
Caterina Disisto, and
Patrizia Celli, and
Maurizio Ferrario, and
Umberto Canosi, and
Carlo Cernetti, and
Francesco Negri, and
Piera Angelica Merlini, and
Marco Tubaro, and
Carlo Berzuini, and
Chiara Manzalini, and
Gianfranco Ignone, and
Carlo Campana, and
Luigi Moschini, and
Elisabetta Ponte, and
Roberto Pozzi, and
Raffaela Fetiveau, and
Silvia Buratti, and
Elvezia Paraboschi, and
Rosanna Asselta, and
Andrea Botti, and
Domenico Tuttolomondo, and
Federico Barocelli, and
Andrea Biagi, and
Rosario Bonura, and
Tiziano Moccetti, and
Antonio Crocamo, and
Giorgio Benatti, and
Giorgia Paoli, and
Emilia Solinas, and
Maria Francesca Notarangelo, and
Elisabetta Moscarella, and
Paolo Calabrò, and
Stefano Duga, and
Giampaolo Niccoli, and
Diego Ardissino
Division of Cardiology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy. Electronic address: magnanigi@ao.pr.it.
BACKGROUND Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. METHODS The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. RESULTS MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57-1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08-0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52-1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87-3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43-1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15-0.47;p < 0.001). CONCLUSIONS MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death,the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.
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