Abstract 4140648: Wake up call for the need of standardized medical management for Myocardial Infarction with non-obstructive coronary arteries (MINOCA): A Meta-analysis

Introduction: Myocardial Infarction with non-obstructive coronary arteries (MINOCA) falls on one end of the spectrum of acute myocardial infarction (AMI) and obstructive coronary disease (OCD) falls on the other end. The pathophysiologic mechanisms behind MINOCA include microvascular dysfunction, coronary spasm and plaque rupture without significant luminal obstruction. Despite its apparent benign anatomical findings, it is associated with major adverse cardiovascular events (MACE). Therapeutic strategies to mitigate the risk of MACE are less defined for MINOCA as compared to OCD. Due to various pathological mechanisms behind MINOCA, it is not certain that the classical medical strategies are optimal therefore there is a dire need for a standardized medical management for this subset of patients. Method: Pubmed database was searched using keywords “MINOCA”, “mortality” and “MACE” from 2015 to 2024. All the relevant observational studies were included using PRISMA guidelines. MACE include in-hospital mortality, heart failure, recurrent myocardial infarction (MI) and stroke. Results: 7 relevant observational studies (N= 579,754) were included in the systematic review. A total of 33,050 patients had MINOCA out of which 5862 (18%) suffered MACE. 4 relevant studies were further assessed to check the specific risk of recurrent MI and stroke in MINOCA population. Out of 30,491 MINOCA patients 1095 (3.6%) had recurrent MI and 742 (2.4%) suffered from stroke. The pooled analysis revealed a statistically significant association between MACE and MINOCA patients (Odds ratio [OR] = 1.44, 95% CI: 1.03 - 2.02, p = 0.03). Further sub-analysis also revealed a statistically significant association between recurrent MI (Odds ratio [OR] = 2.05, 95% CI: 1.15 - 3.68, p = 0.02) and MINOCA. Pooled sub-analysis for association between stroke and MINOCA population was also statistically significant. (Odds ratio [OR] = 0.87, 95% CI: 0.81 - 0.94, p = 0.00) Conclusion: Although MINOCA patients experience fewer MACE as compared to OCD patients, they require a specific standardized medical management to address their pathophysiology and its associated substantial cardiovascular risk. Further research is required to prove these results and to elucidate optimal therapies to improve outcome of patients with MINOCA.