Angina Pectoris Prevalence and Sick Leave Burden 1 Year After Myocardial Infarction With Nonobstructive Coronary Arteries.

BACKGROUND

Symptom burden and disease effects following myocardial infarction with nonobstructive coronary arteries (MINOCA) are not well studied. We aimed to evaluate the prevalence of angina pectoris, sick leave, and quality-of-life levels 1 year after the index event, using patients with myocardial infarction due to obstructive coronary artery disease (MI-CAD) as controls.

METHODS AND

RESULTS

Patients with first-time myocardial infarction, assessed by coronary angiography and registered in the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry 2005 to 2022 were eligible and included if attending the 1-year follow-up. Patients with previous coronary intervention, heart failure, arrhythmia at admission, and not fully revascularized MI-CAD were excluded. Outcomes were prospectively collected during standard care. A total of 46 428 patients (mean age, 62 years; 71% men; MINOCA, n=5281/MI-CAD, n=41 157) were assessed after 1 year. Angina prevalence was 11.6% in MINOCA and 8.8% in fully revascularized MI-CAD (crude risk ratio, 1.32 [95% CI, 1.21-1.47]; odds ratio, 1.18 [95% CI, 1.07-1.30], adjusted for potential confounders). Patients with MINOCA had a higher degree of sick leave than patients with MI-CAD both at index care and at 1 year (8.0% versus 5.6% and 13.4% versus 10.9%, respectively; both P<0.001). Quality-of-life measures were lower in MINOCA. These associations were unaffected when adjusting for angina status but were attenuated when adjusting for potential confounders.

CONCLUSIONS

Patients with MINOCA have significant distress, with higher levels of angina pectoris and sick leave and worse quality of life at 1 year compared with fully revascularized MI-CAD counterparts.