Cardiac rehabilitation in MINOCA patients

Abstract

Funding Acknowledgements Type of funding sources: None. Background and purpose Although cardiac rehabilitation (CR) after myocardial infarction (MI) has been proven to be beneficial, only a minority of patients participate. This study was performed to gain more knowledge about referral and participation rates for CR in patients with myocardial infarction with Nonobstructive Coronary Arteries(MINOCA). Methods All patients meeting the diagnostic MINOCA criteria and admitted between January 2017 and April 2019 were retrospectively analysed. They were divided into the 1) ‘Conclusive MINOCA’ (confirmed MI, (peri)myocarditis, cardiomyopathy, or miscellaneous) and 2) ‘Indeterminate MINOCA’ group. Patients who died in hospital were excluded. Referral and participation in CR was verified. Results Of the 196 included MINOCA patients, 110 (56%) were female and the mean age was 60±13.7 years. 62 Patients(31.6%) had conclusive MINOCA and 134 patients (68.4%) had indeterminate MINOCA. In Figure 1 the distribution of CR referral and participation is shown. Figure 2 shows the referral and participation rates for conclusive and indeterminate MINOCA patients. Conclusive MINOCA patients were more likely to be referred(79.0% vs. 61.9%, p=0.018) and participated more often in CR (45.2% vs. 26.1%, p=0.008). This relation was even stronger when confirmed MI was the final diagnosis as compared to the other MINOCA patients (referral91.3% vs. 64.2%, p=0.009; participation 69.6% vs. 27.2%, p<0.001). Conclusion Only one-third of MINOCA patients participate in CR. Referral and participation rates were significantly higher in MINOCA with confirmed underlying diagnosis (especially confirmed MI) as compared to MINOCA with indeterminate diagnosis. MINOCA patients should be more often referred to CR with a focus on MINOCA with indeterminate underlying diagnosis.