Myocardial infarction with non-obstructive coronary arteries: a single-center retrospective study by sex and race

Abstract

Background: In myocardial infarction with non-obstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race. Objective: Assess baseline demographics and 3-year outcomes by sex and race for MINOCA patients. Methods: Patients admitted to a single center with acute myocardial infarction (AMI) between January 1, 2012 and December 31, 2018, were identified by chart and angiographic review. The primary outcome was nonfatal MI with secondary outcomes including non-fatal cerebrovascular accident (CVA), chest pain readmission, and repeat coronary angiography. Results: During the study period, 304 patients were admitted with MINOCA. The cohort was predominantly female (66.4%), and women were significantly older (64.6 vs. 59.2). One-sixth of the total population were Black patients, and nearly half of Black patients (47.2%) were male. Prior CVA (19.7%) and comorbid anxiety, depression, or post-traumatic stress disorder (41.1%) were common. Rates of non-fatal myocardial infarction (MI) were 6.3% without difference by sex or race. For secondary outcomes, rates of CVA were 1.7%, chest pain readmission were 22.4%, and repeat angiography were 8.9%. Men were significantly more likely to have repeat angiography (13.7% vs. 6.4%), and Black patients more likely to be readmitted for angina (34.0% vs. 19.1%). Over one-quarter of patients underwent repeat stress testing, with 8.9% ultimately undergoing repeat angiograms and low numbers (0.7%) undergoing revascularization. Men were more likely to be referred for a repeat angiogram (13.7% vs. 6.4%, p=0.035). In multivariate analysis, Black race (OR 2.31 [95% CI (1.06-5.03)] was associated with an increased risk of readmission for angina, while female sex was associated with decreased odds of repeat angiography (OR 0.36 [95% CI (0.14-0.90)] and current smoking was associated with increased odds of repeat angiography (OR 4.07 [95% CI (1.02-16.29)] along with hyperlipidemia (OR 4.65 [95% CI (1.22-17.7)]. Conclusion: White women presented more frequently with MINOCA than White men, however Black men are equally as affected as Black women. Rates of non-fatal MI were low without statistical difference by sex or race.