Long-term outcomes of early-onset myocardial infarction with non-obstructive coronary artery disease (MINOCA)

G. Magnani, S. Bricoli, M. Ardissino, G. Maglietta, A. Nelson, G. Malagoli Tagliazucchi, C. Disisto, P. Celli, M. Ferrario, U. Canosi, C. Cernetti, F. Negri, P.A. Merlini, M. Tubaro, C. Berzuini, C. Manzalini, G. Ignone, C. Campana, L. Moschini, E. PonteR. Pozzi, R. Fetiveau, S. Buratti, E. Paraboschi, R. Asselta, A. Botti, D. Tuttolomondo, F. Barocelli, A. Biagi, R. Bonura, T. Moccetti, A. Crocamo, G. Benatti, G. Paoli, E. Solinas, M.F. Notarangelo, E. Moscarella, P. Calabrò, S. Duga, G. Niccoli, D. Ardissino

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Background: Acute myocardial infarction with non-obstructive coronary artery disease (MINOCA) is frequent in patients experiencing an early-onset MI, but data concerning its long-term prognosis are limited and conflicting. Methods: The Italian Genetic Study on Early-onset MI enrolled 2000 patients experiencing a first MI before the age of 45 years, and had a median follow-up of 19.9 years. The composite primary endpoint was cardiovascular (CV) death, non-fatal MI, and non-fatal stroke (MACE); the secondary endpoint was rehospitalisation for coronary revascularisation. Results: MINOCA occurred in 317 patients (15.9%) and, during the follow-up, there was no significant difference in MACE rates between them and the patients with obstructive coronary artery disease (MICAD: 27.8% vs 37.5%; adjusted hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.57–1.09;p = 0.15). The CV death rate was lower in the MINOCA group (4.2% vs 8.4%, HR 0.26, 95%CI 0.08–0.86;p = 0.03), whereas the rates of non-fatal reinfarction (17.3% vs 25.4%; HR 0.76, 95%CI 0.52–1.13;p = 0.18), non-fatal ischemic stroke (9.5% vs 3.7%; HR 1.79, 95%CI 0.87–3.70;p = 0.12), and all-cause mortality (14.1% vs 20.7%, HR 0.73, 95%CI 0.43–1.25;p = 0.26) were not significantly different in the two groups. The rate of rehospitalisation for coronary revascularisation was lower among the MINOCA patients (6.7% vs 27.7%; HR 0.27, 95% CI 0.15–0.47;p < 0.001). Conclusions: MINOCA is frequent and not benign in patients with early-onset MI. Although there is a lower likelihood of CV death, the long-term risk of MACE and overall mortality is not significantly different from that of MICAD patients.

Original languageEnglish
Pages (from-to)7-13
Number of pages7
JournalInternational Journal of Cardiology
Early online date14 Feb 2022
Publication statusPublished - 1 May 2022


  • Early onset myocardial infarction
  • Long-term cardiovascular outcomes
  • Myocardial infarction without obstructive coronary artery disease


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