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Prognosis of MINOCA Compared to Obstructive Myocardial Infarction: A Comparative Analysis
Session:
Sessão de Posters 34 - INOCA, MINOCA e a zona cinzenta da doença coronária
Speaker:
Gonçalo Bettencourt Abreu
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Gonçalo Bettencourt Abreu; Maria Isabel Mendonça; Francisco Sousa; Matilde Ferreira; Francisca Escórcio Silva; Sónia Freitas; Mariana Rodrigues; Eva Henriques; Sofia Borges; António Drumond; Ana Célia Sousa; Roberto Palma Dos Reis
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#0a0a0a">Introduction:</span></strong><span style="color:#0a0a0a"> Some studies showed that the prognosis for patients with Myocardial Infarction (MI) with No Obstructive Coronary Artery Disease (MINOCA) is more favourable compared to those with Obstructive Coronary Artery Disease (CAD). However, it has been proven to be worse than the general population. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="color:#0a0a0a">Objective:</span></strong><span style="color:#0a0a0a"> Evaluate the prognostic value of the MINOCA compared to MI with obstructive CAD in a Southern European population.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> A prospective, single-centre, observational cohort study was performed from January 2000 to December 2023. A total of 1,633 patients with MI were admitted and underwent coronary angiography, being followed for a mean of 7.6±6.7 years. Angiography was evaluated by two interventional cardiologists, who classified it according to the Leaman Score (which quantifies the total burden of CAD based on plaque location, type, and degree of stenosis). A score of zero was established to define MINOCA. Demographic, traditional risk factors and biochemical data were obtained from all patients. Patients with MINOCA were compared to those with obstructive coronary arteries. The primary outcome was the occurrence of cardiovascular events (CVEs) from all causes (MI, revascularisation, heart failure, stroke, peripheral arterial disease, and death). Cox regression analysis identified variables independently associated with CVEs and estimated risk in these populations. Kaplan-Meier assessed event-free survival over time.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Of 1,633 patients with MI, only 87 patients (5.3%) had MINOCA, and 1,546 (94.7%) had obstructive CAD. Within MINOCA, 16.1% had CVEs, and 42.2% had CVEs in those with obstructive CAD. The Kaplan-Meier analysis showed that MINOCA patients had a higher event-free probability throughout follow-up. Specifically, at 10 years, the event-free rate was 79.6% vs 40.3% in the MI with obstructive CAD. After Cox regression analysis, the risk of CVEs for patients with MI with obstructive CAD was three times higher than that of those with MINOCA (HR=3.2; 95% CI: 1.9-5.4; p<0.0001). The other variables independently associated with CVEs were diabetes (p=0.041) and physical inactivity (p=0.005).</span></span></p> <p><strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion:</span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"> Although MINOCA patients show a significantly better prognosis than those with obstructive MI, the condition is not benign. The broader MINOCA spectrum remains associated with recurrent symptoms, frequent healthcare use, and a long-term risk profile that, while lower than obstructive CAD, progressively converges over time.</span></span></p>
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