Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Mar 4;14(5):e036802.
doi: 10.1161/JAHA.124.036802. Epub 2025 Feb 19.

Clinical Characteristics and Outcome of Patients With Myocardial Infarction With Nonobstructive Coronary Arteries in Japan: Insights From the Miyagi Acute Myocardial Infarction Registry Study

Kiyotaka Hao  1 , Jun Takahashi  1 , Koichi Sato  1   2 , Kento Fukui  1 , Tomohiko Shindo  1 , Kazuma Oyama  1 , Kensuke Nishimiya  1 , Shigeo Godo  1 , Takashi Shiroto  1 , Hiroaki Shimokawa  1   2 , Satoshi Yasuda  1
Affiliations
Observational Study

Clinical Characteristics and Outcome of Patients With Myocardial Infarction With Nonobstructive Coronary Arteries in Japan: Insights From the Miyagi Acute Myocardial Infarction Registry Study

Kiyotaka Hao et al. J Am Heart Assoc. .

Abstract

Background: Clinical characteristics and outcomes of patients with myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) are not fully understood, particularly in Japan.

Methods and results: We enrolled a total of 8881 patients with acute MI from the Miyagi Acute Myocardial Infarction Registry Study (2012-2020), with a median age of 69 years. Among them, 239 patients (2.7%) were diagnosed with MINOCA. Compared with those with MI with obstructive coronary artery disease (MI-CAD), patients with MINOCA were more often women, had a higher incidence of non-ST-segment-elevation MI and a lower prevalence of dyslipidemia. Compared with patients with MI-CAD, patients with MINOCA in all age groups (<59, 60-69, 70-79, >80 years of age) had a higher incidence of non-ST-segment-elevation MI. Additionally, those ≤59 years of age were more often women and had a lower prevalence of diabetes and dyslipidemia. In-hospital mortality increased with age in patients with MI-CAD (3.9% for <59 years of age, 5.6% for 60-69 years of age, 8.3% for 70-79 years of age, and 15.2% for >80 years of age; P<0.01), but not in patients with MINOCA (4.5%, 7.4%, 6.0%, and 9.6%, respectively; P=0.36). Compared with patients with MI-CAD, patients with MINOCA had lower in-hospital mortality for Killip class IV (40.7% versus 20.0%; adjusted odds ratio [OR], 0.31 [95% CI, 0.10-0.94]; P=0.04) and renal dysfunction (20.0% versus 7.1%; adjusted OR, 0.29 [95% CI, 0.09-0.96]; P=0.04).

Conclusions: Patients with MINOCA exhibit distinct clinical characteristics and outcomes compared with those with MI-CAD, particularly in terms of age, sex, prevalence of comorbidities, and in-hospital mortality. These findings underscore the importance of tailored clinical approaches for patients with MINOCA.

Keywords: acute myocardial infarction; nonobstructive coronary artery; prognosis.

PubMed Disclaimer

Conflict of interest statement

Dr Shimokawa received lecture fees from Bayer Yakuhin (Osaka, Japan) and Daiichi Sankyo (Tokyo, Japan). Dr Yasuda received grant support from Takeda Pharmaceutical, Abbott, and Boston Scientific; and lecture fees from Daiichi Sankyo and Bristol Myers Squibb. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Prevalence of MINOCA by age.
A, Overall population. B, Male and female patients. MINOCA indicates myocardial infarction with nonobstructive coronary arteries.
Figure 2
Figure 2. Clinical characteristics of patients with MINOCA and MI‐CAD by age.
The difference between patients with MINOCA and MI‐CAD in the prevalence of hypertension, diabetes, dyslipidemia, current smoking, renal failure, NSTEMI, and Killip class IV on admission is shown. MI‐CAD indicates myocardial infarction with obstructive coronary artery disease; MINOCA, myocardial infarction with nonobstructive coronary arteries; and NSTEMI, non–ST‐segment–elevation myocardial infarction.
Figure 3
Figure 3. In‐hospital mortality of patients with MINOCA and MI‐CAD in subgroups.
Multivariable logistic regression analyses were performed to adjust for age and sex. MI‐CAD indicates myocardial infarction with obstructive coronary artery disease; MINOCA, myocardial infarction with nonobstructive coronary arteries; NSTEMI, non–ST‐segment–elevation myocardial infarction; OR, odds ratio; and STEMI, ST‐segment–elevation myocardial infarction.
Figure 4
Figure 4. In‐hospital mortality of patients with MINOCA and MI‐CAD by age and Killip class on admission.
MI‐CAD indicates myocardial infarction with obstructive coronary artery disease; and MINOCA indicates myocardial infarction with nonobstructive coronary arteries.
See this image and copyright information in PMC

References

    1. Gehrie ER, Reynolds HR, Chen AY, Neelon BH, Roe MT, Gibler WB, Ohman EM, Newby LK, Peterson ED, Hochman JS. Characterization and outcomes of women and men with non‐ST‐segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. Am Heart J. 2009;158:688–694. doi: 10.1016/j.ahj.2009.08.004 - DOI - PubMed
    1. Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, van de Werf F, Aylward P, Topol EJ, Califf RM. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. N Engl J Med. 1999;341:226–232. doi: 10.1056/NEJM199907223410402 - DOI - PubMed
    1. Baccouche H, Mahrholdt H, Meinhardt G, Merher R, Voehringer M, Hill S, Klingel K, Kandolf R, Sechtem U, Yilmaz A. Diagnostic synergy of non‐invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin‐positive patients without coronary artery disease. Eur Heart J. 2009;30:2869–2879. doi: 10.1093/eurheartj/ehp328 - DOI - PubMed
    1. Pasupathy S, Air T, Dreyer RP, Tavella R, Beltrame JF. Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries. Circulation. 2015;131:861–870. doi: 10.1161/CIRCULATIONAHA.114.011201 - DOI - PubMed
    1. Hokimoto S, Kaikita K, Yasuda S, Tsujita K, Ishihara M, Matoba T, Matsuzawa Y, Mitsutake Y, Mitani Y, Murohara T, et al. JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. Circ J. 2023;87:879–936. doi: 10.1253/circj.CJ-22-0779 - DOI - PubMed

Publication types

LinkOut - more resources