Mental disorders, psychotropic drug dispensation and unfavourable sociodemographic factors in patients with myocardial infarction with and without obstructive coronary arteries.

BACKGROUND

Knowledge on the influence of mental disorders and unfavourable sociodemographic factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) remains limited. We investigated the prevalence of mental disorders, psychotropic drug dispensation, and sociodemographic factors in patients with MINOCA and MI with coronary artery disease (MI-CAD) and assessed their association with prognosis.

METHODS AND

RESULTS

In this nationwide register-based cohort study of 8367 MINOCA and 109,059 MI-CAD patients, mental disorders (4.3% vs 2.6%, p < 0.001) and psychotropic drug dispensation (26.1% vs 17.4%, p < 0.001) were more frequent in MINOCA, particularly female patients. MINOCA patients were also more often divorced (21.1% vs 19.7%, p < 0.001), widowed (6.8% vs 4.9%, p < 0.001), or on sick leave (4.4% vs 3.2%, p < 0.001). Over a median 5.5-year follow-up, a major adverse cardiovascular event (MACE) occurred in 25.5% of MINOCA and 27.8% of MI-CAD patients (p < 0.001). Adjusted analyses showed that mental disorders and dispensed psychotropic drugs independently predicted MACE in both MINOCA (HR 1.27; 95% CI 1.15-1.40) and MI-CAD (HR 1.35; 95% CI 1.31-1.39).

CONCLUSION

Mental disorders and psychotropic drug dispensation were more common in MINOCA than MI-CAD, particularly in female patients. Unfavourable sociodemographic factors were common in both groups, with a modest excess in MINOCA. The association between mental health variables and adverse outcomes in both conditions suggests shared mechanisms beyond traditional cardiovascular risk factors.