Long term all-cause mortality after myocardial infarction with non-obstructed vs obstructed coronary artery disease: a meta-analysis of adjusted data

Abstract

Background The difference in the long-term outcomes of myocardial infarction in patients with non-obstructed coronary arteries (MINOCA) and patients with myocardial infarction with obstructed coronary artery disease (MI-CAD) is not clear. The current study aimed to pool adjusted data to compare long-term outcomes of MINOCA vs MI-CAD. Methods Electronic literature search of PubMed, Embase, CENTRAL, and Google Scholar databases was done for publications up to 18th June 2023. Only studies reporting multivariable-adjusted data with > 1 year of follow-up were included. Results Sixteen studies met the inclusion criteria. Our meta-analysis revealed no statistically significant difference in the risk of all-cause mortality between MINOCA and MI-CAD patients (HR: 0.90 95% CI 0.68, 1.19 I2 = 94% p = 0.48). Analysis of the limited data showed a reduced combined risk of all-cause mortality and MI (HR: 0.54 95% CI 0.39, 0.76 I2 = 72% p = 0.003) and major adverse cardiac events (MACE) (HR: 0.66 95% CI 0.51, 0.84 I2 = 51% p = 0.0009) in patients with MINOCA vs MI-CAD, and no difference in the risk of cardiovascular mortality (HR: 0.81 95% CI 0.54, 1.22 I2 = 0% p = 0.31) and readmission between the two groups (HR: 0.85 95% CI 0.61, 1.19 I2 = 90% p = 0.35). Conclusion A pooled analysis of adjusted outcomes from the available studies indicated that MINOCA and MI-CAD patients have similar long-term all-cause mortality risk. Our conclusions on the risk of cardiovascular mortality, MACE and readmission rates need to be taken with caution due to a lack of adequate studies. Further research is needed to strengthen the evidence on this important subject.

Acute myocardial infarction without obstructive lesions, a retrospective study in older adult patients in a Latin American hospital.

“…Approximately 5-10% of MINOCA patients die from any cause (17). When analyzing the existing body of scientific research, the long-term effects are not clearly known (18). Furthermore, regarding secondary prevention, the research conducted thus far has not yielded conclusive scientific proof of the molecules that could be advantageous for these individuals; this is one of the aspects that will be examined in the years to come (19).Although other investigations (10) did not find any changes in the outcomes between the groups with or without ST elevation following a 4-year follow-up, we are unable to assess this association because our study is retrospective in nature.…”

“…Furthermore, regarding secondary prevention, the research conducted thus far has not yielded conclusive scientific proof of the molecules that could be advantageous for these individuals; this is one of the aspects that will be examined in the years to come (19).Although other investigations (10) did not find any changes in the outcomes between the groups with or without ST elevation following a 4-year follow-up, we are unable to assess this association because our study is retrospective in nature. As one of the pillars to be taken into consideration for later phases, we must also bring up the article (18), in which the authors developed a risk score to predict MINOCA in patients with STEMI generally.…”