P880Cardiovascular mortality in patients with MINOCA and prognostic effect of statin treatment
Authors: Cespon Fernandez M , Abu-Assi E , Raposeiras Roubin S , Munoz Pousa I , Dominguez Rodriguez L M , Dominguez Erquicia P , Cobas Paz R , Caneiro Queija B , Jamhour Chelh K , Perez Casares L E , Lopez Rodriguez E , Castineira Busto M , Fernandez Barbeira S , Iniguez Romo A 
Published: October 2019

Abstract

Introduction
Several studies have showed a substantial risk of death in patients with MINOCA. However, little is still known about the causes of death in these patients compared to patients with MI with significant coronary lesions. On the other hand, using statins treatment in MINOCA has demonstrated to have prognosis benefit in a recent observational. In this study, we aim to describe the previous aspects in a contemporary cohort of patients with AMI.

Methods
We analyzed retrospective data from 4,499 consecutive patients discharged with a confirmed diagnosis of AMI from January/2010 to December/2016. Patients with coronary lesions <50% were classified as MINOCA. Patients with Tako-Tsubo syndrome were excluded. The time to death in patients with MINOCA vs MI-OCA was analyzed and the causes of death (CV death and non-CV death) were compared. When the cause of death was unknown, it was classified as unknown. The log-rank test was used to find differences in death rate between both groups. The effect of statin treatment was tested.

Results
643 patients (14.3%) were diagnosed with MINOCA. The prevalence of women was higher among patients with MINOCA (42.8% vs. 22.6%, p<0.01). The MINOCA were older (69±13 years vs. 66±13 years, p<0.01) with a higher prevalence of hypertension (70.85% vs. 65.3%, p=0.007), previous stroke (10.65 vs. 7.0%; p=0.001), COPD (14.0% vs. 9.95, p=0.002) and cancer history (9.2% vs. 7.6%, p=0.16). In contrast, the MINOCA patients had a lower prevalence of active smoking (19.9% vs. 35%, p<0.01), DM (33.0 vs. 29.4%, p=0.07), dyslipidemia (65.8% vs. 66.3%, p=0.81) and peripheral arteriography (7.3% vs. 8.3%, p=0.41). STEMI was the most frequent form of hospital presentation in the MINOCA cohort (41.95% vs. 19.1%). LVEF was higher in the MINOCA cohort (55% ± 11% vs. 52% ± 10%, p=0.006).
At discharge, 86.5% of MINOCAs were treated with statin vs. 86.5% in MI-OCA. The statins prescribed at discharge were of higher potency at 78.2% in MINOCA vs. 88.1% in MI-OCA, moderate potency in 16.1% vs 9.5%, and lower potency in 5.7% vs. 2.4%, respectively (p=0.001).
During a median follow-up of 15 months (IQR: 12.6–26.0 months), there were 383 deaths (8.5%), of which 314 occurred in the MI-OCA cohort (8.2%) and 69 occurred in MINOCA cohort (11.1%); p=0.001.
47.8% (n=33/69) were deaths of CV origin in the MINOCA group vs. 48.1% (n=151/314) in the MI-OCA group (p=0.61). The cause of death could not be determined in 6 patients (8.7%) with MINOCA and in 46 (14.7%) with MI-OCA (p=0.19).
No benefit of the statin treatment of any potency was observed in MINOCA (HR=0.8 [95% CI: 0.4–1.6]) whether there was benefit in MI-OCA group (HR=0.7 [95% CI 0.5–0.98]).

Conclusions
There is a considerable difference in the comorbidities between MINOCA and MI-OCA, but a similar rate of death of CV origin in the medium term. The lack of benefit of statin treatment has to be confirmed in other larger studies.