Differences between MINOCA and type 2 myocardial infarction: An ITALIAN observational study

Area of Science:

• Cardiology
• Clinical Medicine
• Internal Medicine

Background:

• Myocardial infarction with non-obstructive coronary arteries (MINOCA) and type 2 myocardial infarction (MI) share overlapping symptoms, often presenting as non-ST-elevation MI (NSTEMI).
• Current clinical practice frequently groups these conditions due to similar presentations.
• This grouping can obscure distinct characteristics and prognoses.

Purpose of the Study:

• To compare the clinical characteristics and long-term prognosis of MINOCA and type 2 MI.
• To identify predictors that can differentiate between MINOCA and type 2 MI.
• To inform clinical decision-making and improve patient stratification.

Main Methods:

• Retrospective analysis of 7815 NSTEMI patients undergoing coronary angiography (2005-2022).
• Identification of 538 patients diagnosed with MINOCA (n=301) or type 2 MI (n=237).
• Composite endpoint included all-cause mortality, non-fatal MI, heart failure hospitalization, and stroke/TIA.

Main Results:

• MINOCA patients were younger (66.3 vs. 70.6 years) and had fewer cardiovascular risk factors than type 2 MI patients.
• Multivariable analysis identified distinct clinical and instrumental predictors for MINOCA (AUC 0.83).
• MINOCA patients exhibited a significantly lower rate of the composite endpoint (20% vs. 32%) at a median 61-month follow-up.

Conclusions:

• MINOCA is characterized by different patient demographics and clinical profiles compared to type 2 MI.
• MINOCA is associated with a significantly better prognosis than type 2 MI, despite a non-negligible event rate.
• Distinguishing between MINOCA and type 2 MI is essential for accurate risk assessment and management.