Background
Myocardial infarction with nonobstructive coronary arteries (
MINOCA ) is a heterogeneous disease entity. Its prognosis and predictor of mortality remain unclear. This study aimed to compare the prognosis between
MINOCA and
myocardial infarction with obstructive
coronary artery disease and identify factors related to all-cause death in
MINOCA using a nation-wide, multicenter, and prospective registry. Methods and Results Among 13 104 consecutive patients enrolled, patients without previous history of significant
coronary artery disease who underwent coronary angiography were selected. The primary outcome was 2-year all-cause death. Secondary outcomes were
cardiac death, noncardiac death, reinfarction, and repeat revascularization. Patients with
MINOCA (n=396) and
myocardial infarction with obstructive
coronary artery disease (n=10 871) showed similar incidence of all-cause death (9.1% versus 8.8%; hazard ratio [ HR ], 1.04; 95% CI, 0.74-1.45; P=0.83). Risks of
cardiac death, noncardiac death, and reinfarction were not significantly different between the 2 groups ( HR , 0.82; 95% CI , 0.53-1.28; P=0.38; HR , 1.55; 95% CI , 0.93-2.56; P=0.09; HR , 1.23; 95% CI , 0.65-2.31; P=0.38, respectively).
MINOCA patients had lower incidence of repeat revascularization (1.3% versus 7.2%; HR , 0.17; 95% CI , 0.07-0.41; P<0.001). Results were consistent after multivariable regression and propensity-score matching. In a multivariate model, several significant predictors of all-cause death of
MINOCA were found, including the nonuse of renin-angiotensin system blockers ( HR , 2.63; 95% CI , 1.08-6.25; P=0.033) and
statins ( HR , 2.17; 95% CI , 1.04-4.54; P=0.039). Conclusions Patients with
MINOCA and those with
myocardial infarction with obstructive
coronary artery disease had comparable clinical outcomes. Use of renin-angiotensin system blockers and
statins was associated with lower mortality in patients with
MINOCA .