Abstract 4369778: Does Obesity Influence Cardiovascular Outcomes in Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)? Insights from a Propensity-Matched National Cohort

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a unique clinical entity with heterogeneous etiologies. The impact of obesity on cardiovascular outcomes in this population remains uncertain. This study aimed to assess the association between obesity and the risk of heart failure hospitalizations, stroke, atrial fibrillation, and all-cause mortality in MINOCA patients. Methods: This retrospective cohort study utilized TriNetX, a federated health research network capturing data from 67 healthcare organizations across the U.S. Patients diagnosed with MINOCA (ICD-10: I21.B) were divided into two groups: those with a diagnosis of obesity and those without. Propensity score matching (1:1) was performed on age and sex to balance baseline characteristics. Outcomes were assessed up to 5 years post-index diagnosis and included heart failure hospitalizations, stroke, atrial fibrillation, and all-cause mortality. Statistical analyses included risk differences, odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs). A p-value <0.05 was considered significant. Results: After matching, 516 patients were included (258 per group). There were no significant differences in the risk of heart failure hospitalizations (risk difference -0.014, 95% CI [-0.075, 0.046], HR 0.79, 95% CI [0.35, 1.79], p=0.642), stroke (risk difference -0.012, 95% CI [-0.047, 0.024], HR 0.64, 95% CI [0.11, 3.85], p=0.522), atrial fibrillation (risk difference 0.005, 95% CI [-0.037, 0.048], HR 1.22, 95% CI [0.41, 3.62], p=0.811), or all-cause mortality (risk difference 0.016, 95% CI [-0.021, 0.052], HR 2.25, 95% CI [0.86, 5.85], p=0.403) between the obese and non-obese cohorts. Kaplan-Meier survival analyses revealed no significant differences in survival probabilities across these outcomes. Conclusions: In this large, propensity-matched cohort of MINOCA patients, obesity was not significantly associated with increased risk of heart failure hospitalizations, stroke, atrial fibrillation, or all-cause mortality over 5 years. These findings suggest that obesity may not independently worsen cardiovascular outcomes in the MINOCA population, although the small sample size and wide confidence intervals warrant caution in interpretation. Future studies with larger cohorts and mechanistic insights are needed to clarify the role of obesity in MINOCA and to inform personalized management strategies.