Women at higher risk of MINOCA-driven MACE, study finds

USA: A new study hypothesized that major adverse clinical events (MACE) led by small vessel disease associated with myocardial infarction with the nonobstructive coronary artery (MINOCA) are more commonly seen in women than men. The study was published in the International Journal of Cardiology.

Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is receiving attention as a prognostically adverse entity distinct from myocardial infarction with significant coronary artery disease. The sex differences in clinical presentation, treatment, and outcomes of patients with acute myocardial infarction (AMI) have been under investigation for a long time now. Among patients who present with acute myocardial infarction (MI), 2–6% are found to have non-obstructive coronary arteries (NOCA). Reports suggest that MINOCA represents approximately 10% of acute coronary syndromes. Patients with MINOCA are more commonly women and present at a younger age (51–59 years). Among patients with MINOCA, the influence of sex on adverse events remains unclear.

To determine sex-related differences in clinical outcomes, Rahul Chaudhary, University of Pittsburgh Medical Center, USA, and his investigative team performed a systematic review on MINOCA patients.

Investigators searched PubMed, MEDLINE, CENTRAL (Cochrane Central Register of Controlled Trials), EMBASE, EBSCO, Web of Science, and CINAHL databases for trials comparing gender differences in clinical outcomes among patients with MINOCA from inception through April 10, 2022. Seven studies with a total of 28,671 MINOCA patients were included (n = 11,249 men and n = 17,422 women) over a mean follow-up of 2 years. The primary endpoint of the study was composite major adverse clinical events (MACE) including all-cause mortality, non-fatal MI, stroke, and cardiovascular readmissions. Secondary endpoints were the individual components of the MACE.

Key findings of the analysis,

• Women had more MACE than men (10.1% vs. 9.1%).

• Among secondary endpoints, only the incidence of stroke was higher in women (3.5% vs. 2.2%, p < 0.05).

• All-cause mortality, non-fatal MI, and cardiovascular readmissions were not significantly different between the two groups.

The investigators conclude that women are more prone to MACE occurring due to small vessel disease associated with MINOCA as compared to men. Reduction in estrogen, hypercoagulability and underprescribing may be the contributing factors to these differences in the sex-related outcomes.

Rahul Chaudhary, Michael Bashline, Enrico M. Novelli, Kevin P. Bliden, Udaya S. Tantry, Oladipupo Olafiranye, Aref Rahman, Paul A. Gurbel, John J. Pacella,

Sex-related differences in clinical outcomes among patients with myocardial infarction with nonobstructive coronary artery disease: A systematic review and meta-analysis, International Journal of Cardiology,2022,https://doi.org/10.1016/j.ijcard.2022.07.050.