To Örebro University

Aims: Myocardial infarction with non-obstructive coronary arteries (MINOCA) and takotsubo syndrome (TS) are both characterized by lack of significant coronary artery stenoses and a higher prevalence of mental health disorders preceding the event. Currently, little is known about their pathological aetiologies and subsequent treatment plans, giving cause for concern among those affected. The objective of this review is to provide a comprehensive overview of mental health status and quality of life (QoL) in MINOCA and TS patients after the acute event, compared with both cardiac and non-cardiac populations, and over time.

Methods and results: A systematic search was conducted via Cochrane Library, CINAHL, PsycINFO, PubMed, ASSIA, Web of Science, Scopus, and Embase from inception to May 2024. The review was registered in PROSPERO and methods, and results were reported in accordance with the PRISMA guidelines. Quality assessment and risk of bias were evaluated using the Newcastle-Ottawa Scale for cross-sectional and cohort studies. Sample sizes ranged from 13 to 5322 participants. The risk of bias was high in 18/28, medium in 7/28, and low in 3/28 studies. Across the symptoms assessed, MINOCA and TS patients reported worse mental health status or QoL than non-cardiac groups in 10/13 studies and cardiac groups in 10/20 studies. Investigating change over time, 1/5 studies found deteriorating mental health status, 3/5 reported improved mental health status or QoL, and 1/5 reported no change in MINOCA and TS patients.

Conclusion: Patients with MINOCA or TS seem to have worse mental health status and QoL after the acute event than non-cardiac individuals, but it is yet difficult to conclude whether mental distress and QoL are equal or worse compared with coronary heart disease patients. There is no convincing evidence that mental health status or QoL of MINOCA and TS patients naturally improve over time after the acute event. Among the studies evaluated, risk of bias was high. More high-quality studies are needed, investigating mental health status and QoL among MINOCA and TS patients.

Lay summary: This is a systematic review of all papers reporting data on post-event mental health status and quality of life in individuals following either a MINOCA or takotsubo syndrome.

• Individuals who have suffered a MINOCA or takotsubo syndrome more often report worse mental health status and quality of life than healthy controls and at least as often or more often than other cardiac patients.
• Much of the available data had a high risk of bias, demonstrating a lack of high-quality investigation of the mental well-being of these patients, and more attention is warranted.