METHODS AND RESULTS: Multicentre, observational cohort study of patients with AMI (≥65 years) from the National Cardiovascular Data Registry CathPCI Registry (July 2009-December 2013) who underwent coronary angiography with linkage to the Centers for Medicare and Medicaid (CMS) claims data. Patients were classified as MICAD or
MINOCA by the presence or absence of an epicardial vessel with ≥50%
stenosis. The primary endpoint was
MACE at 12 months, and secondary endpoints included the components of
MACE over 12 months. Among 286 780 AMI admissions (276 522 unique patients), 16 849 (5.9%) had
MINOCA. The 12-month rates of
MACE (18.7% vs. 27.6%), mortality (12.3% vs. 16.7%), and re-hospitalization for AMI (1.3% vs. 6.1%) and HF (5.9% vs. 9.3%) were significantly lower for
MINOCA vs. MICAD patients (P < 0.001), but was similar between
MINOCA and MICAD patients for re-hospitalization for
stroke (1.6% vs. 1.4%, P = 0.128). Following risk-adjustment,
MINOCA patients had a 43% lower risk of
MACE over 12 months (hazard ratio = 0.57, 95% confidence interval 0.55-0.59), in comparison to MICAD patients. This pattern was similar for adjusted risks of the
MACE components.
CONCLUSION: This study confirms an unfavourable prognosis in elderly patients with
MINOCA undergoing coronary angiography, with one in five patients with
MINOCA suffering a major adverse event over 12 months.