Abstract 15980: Characteristics and Outcomes of Myocardial Infarction With Nonobstructive Coronary Arteries Among 7,015,435 Hospitalizations in California
Introduction: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is is less well characterized in terms of risk factors and prognosis than AMI with obstructive coronary artery disease (AMI-CAD).
Methods: Among 7,015,435 hospitalized adults in California captured by the Healthcare Cost and Utilization Project between 2005-2009, we studied the prevalence of MINOCA and its specific subtypes including coronary vasospasm, coronary artery dissection, Takotsubo cardiomyopathy, hypercoagulable state, and coronary artery anomaly using ICD-9 codes. We used Cox proportional hazards model for major adverse cardiac events (MACE), including MI, heart failure, and death (follow up until 2011) and rehospitalization.
Results: 1,585 had MINOCA and 175,809 had AMI-CAD. Among all MINOCA, 46% had coronary artery dissection, 21% had Takotsubo, 14% had a coronary artery anomaly, 13% had coronary vasospasm, and 6% had a hypercoagulable state. Diabetes, hypertension were lower and obesity rates higher in MINOCA vs. AMI-CAD. MINOCA had a reduced risk of MACE compared to AMI-CAD (Figure). With the exception of Takotsubo, each individual MINOCA subtype exhibited higher rates of MACE compared to general hospitalized population without AMI-CAD (n=6,838,041). There was a reduced risk of rehospitalization for Takotsubo [HR=0.67 (95% CI 0.56-0.80) <0.0001] but not for other MINOCA subtypes compared to the general population.
Conclusions: Coronary artery dissection is the most common cause of MINOCA in hospitalized California adults over a 5 year period. Aside from Takotsubo, patients with MINOCA demonstrated an increased risk of future MACE as compared to the general hospitalized population. Takotsubo is the only MINOCA subtype with a significant reduced risk of re-hospitalization.
Author Disclosures: C.B. Khoury: None. G. Nah: None. Z.H. Tseng: None. R. Arnaout: None. G.M. Marcus: None. N.I. Parikh: None.
- © 2016 by American Heart Association, Inc.