Myocardial infarction with non-obstructive coronary arteries: a single-center retrospective study by sex and race

Background In myocardial infarction with non-obstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race. Objective Assess baseline demographics and 3-year outcomes by sex and race for MINOCA patients. Methods Patients admitted to a single center with acute myocardial infarction (AMI) between January 1, 2012 and December 31, 2018, were identified by chart and angiographic review. The primary outcome was nonfatal MI with secondary outcomes including non-fatal cerebrovascular accident (CVA), chest pain readmission, and repeat coronary angiography. Results During the study period, 304 patients were admitted with MINOCA. The cohort was predominantly female (66.4%), and women were significantly older (64.6 vs. 59.2). One-sixth of the total population were Black patients, and nearly half of Black patients (47.2%) were male. Prior CVA (19.7%) and comorbid anxiety, depression, or post-traumatic stress disorder (41.1%) were common. Rates of non-fatal myocardial infarction (MI) were 6.3% without difference by sex or race. For secondary outcomes, rates of CVA were 1.7%, chest pain readmission were 22.4%, and repeat angiography were 8.9%. Men were significantly more likely to have repeat angiography (13.7% vs. 6.4%), and Black patients more likely to be readmitted for angina (34.0% vs. 19.1%). Over one-quarter of patients underwent repeat stress testing, with 8.9% ultimately undergoing repeat angiograms and low numbers (0.7%) undergoing revascularization. Men were more likely to be referred for a repeat angiogram (13.7% vs. 6.4%, p=0.035). In multivariate analysis, Black race (OR 2.31 [95% CI (1.06-5.03)] was associated with an increased risk of readmission for angina, while female sex was associated with decreased odds of repeat angiography (OR 0.36 [95% CI (0.14-0.90)] and current smoking was associated with increased odds of repeat angiography (OR 4.07 [95% CI (1.02-16.29)] along with hyperlipidemia (OR 4.65 [95% CI (1.22-17.7)]. Conclusion White women presented more frequently with MINOCA than White men, however Black men are equally as affected as Black women. Rates of non-fatal MI were low without statistical difference by sex or race. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial This is not a prospective analysis. ### Funding Statement No funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approved by Yale IRB. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data is Yale data accessed after IRB approval for retrospective review. No external datasets used.