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MINOCA Syndrome stratified by sex: What differs?
Session:
Sessão de Posters 34 - INOCA, MINOCA e a zona cinzenta da doença coronária
Speaker:
Ana Filipa Escórcio Silva
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.1 Acute Coronary Syndromes – Pathophysiology and Mechanisms
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Filipa Escórcio Silva; Maria Isabel Mendonça; Gonçalo Abreu; Francisco Sousa; Matilde Ferreira; Eva Henriques; Sónia Freitas; Mariana Rodrigues; Sofia Borges; António Drumond; Ana Célia Sousa; Roberto Palma Dos Reis
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Myocardial infarction with non-obstructive coronary arteries (MINOCA) may arise from genetic susceptibility, involving mechanisms linked to coronary microvascular dysfunction and thrombotic events. Evidence suggests sex-related differences in MINOCA presentation, although findings remain inconsistent.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> Stratify the MINOCA population by sex according to the main genetic, behavioural, and traditional risk factors in a Southern European population.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong>This prospective, single-centre cohort included 1,633 patients admitted with myocardial infarction between January 2000 and December 2023. Coronary angiography was assessed by two interventional cardiologists using the Leaman Score to quantify coronary artery disease (CAD) burden; a score of 0 defined MINOCA. MINOCA patients were stratified by sex and compared with obstructive (MI-CAD).<strong> </strong>Thirty-three single-nucleotide polymorphisms (SNPs) previously associated with CAD were genotyped using TaqMan assays.<strong> </strong>Associations between genetic variants and traditional risk profile and MI-CAD were evaluated for both sex, using bivariate and multivariate logistic regression.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>MINOCA was diagnosed in 87 (5.3%) of patients: 29 women and 58 men. Women with MINOCA showed lower prevalence of type 2 diabetes (p=0.005) and metabolic syndrome (p=0.003), and reported higher physical activity (p<0.0001) compared with MI-CAD women. Genetic variants PON1 rs854560 (p=0.040) and CDKN2B rs4977574 (p=0.036) showed significance; but after multivariate adjustment, only CDKN2B GG remained independently associated with MI-CAD (p=0.020). Only type 2 diabetes (p=0.025), age (p=0.012) and physical inactivity (p=0.008) retained independent associations. Men with MINOCA showed lower rates of hypertension (p=0.033), diabetes (p=0.021), and metabolic syndrome (p=0.042) versus MI-CAD. Significant SNPs associations included TCF21 rs12190287 (p<0.0001), FTO rs9939609 (p=0.048), and PCSK9 rs562556 (p=0.038). When adjusted in multivariate logistic regression, TCF21 GC+CC (p<0.0001) and PCSK9 GA+AA (p=0.042) remained independently associated with MI-CAD, along with age (p<0.0001).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>Women<strong> </strong>and men with MINOCA exhibit a more favourable cardiometabolic profile than those with MI-CAD, with lower metabolic risk burden. Both sexes presented genetic contributors to MI-CAD, particularly variants in TCF21, CDKN2B, PCSK9, FTO and PON1, supporting a genetic predisposition to mechanisms such as endothelial dysfunction, vasospasm, and thrombotic events. </span></span></span></p>
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