To Örebro University

BACKGROUND: Symptom burden and disease effects following myocardial infarction with nonobstructive coronary arteries (MINOCA) are not well studied. We aimed to evaluate the prevalence of angina pectoris, sick leave, and quality-of-life levels 1 year after the index event, using patients with myocardial infarction due to obstructive coronary artery disease (MI-CAD) as controls.

METHODS AND RESULTS: Patients with first-time myocardial infarction, assessed by coronary angiography and registered in the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry 2005 to 2022 were eligible and included if attending the 1-year follow-up. Patients with previous coronary intervention, heart failure, arrhythmia at admission, and not fully revascularized MI-CAD were excluded. Outcomes were prospectively collected during standard care. A total of 46 428 patients (mean age, 62years; 71% men; MINOCA, n=5281/MI-CAD, n=41 157) were assessed after 1 year. Angina prevalence was 11.6% in MINOCA and 8.8% in fully revascularized MI-CAD (crude risk ratio, 1.32 [95% CI, 1.21-1.47]; odds ratio, 1.18 [95% CI, 1.07-1.30], adjusted for potential confounders). Patients with MINOCA had a higher degree of sick leave than patients with MI-CAD both at index care and at 1 year (8.0% versus 5.6% and 13.4% versus 10.9%, respectively; both P<0.001). Quality-of-life measures were lower in MINOCA. These associations were unaffected when adjusting for angina status but were attenuated when adjusting for potential confounders.

CONCLUSIONS: Patients with MINOCA have significant distress, with higher levels of angina pectoris and sick leave and worse quality of life at 1 year compared with fully revascularized MI-CAD counterparts.