AUTHOR=Stepien Konrad , Nowak Karol , Szlosarczyk Barbara , Nessler Jadwiga , Zalewski Jaroslaw 

TITLE=Clinical Characteristics and Long-Term Outcomes of MINOCA Accompanied by Active Cancer: A Retrospective Insight Into a Cardio-Oncology Center Registry

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.785246

DOI=10.3389/fcvm.2022.785246

ISSN=2297-055X

ABSTRACT=Background: Clinical characteristics and long-term outcomes of patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and cancer are insufficiently elucidated. 
Objectives: We sought to characterize these patients hospitalized in a tertiary cardio-oncology center and to find the potential determinants affecting their long-term mortality.
Methods: MINOCA was diagnosed in 72 of the 1,011 consecutive myocardial infarction patients who underwent coronary angiography. Mortality rates and their determinants were analyzed within a median follow-up of 69.2 (37.8-79.9) months.
Results: Active cancer was identified in 21 (29.2%) of MINOCA patients and in 113 (12.0%) patients with myocardial infarction and obstructive coronary artery disease (MI-CAD) (P<0.001). MINOCA patients with cancer were characterized by a higher incidence of anemia (47.6 vs 21.6%, P=0.03) and more frequent Takotsubo syndrome (19.1 vs 2.0%, P=0.01) than in non-cancer MINOCA. The troponin T/hemoglobin ratio was higher in both cancer MINOCA and MI-CAD groups when compared with their respective non-cancer patients (both P<0.05). The age- and sex-standardized mortality rates were significantly higher in cancer MINOCA (26.7%/year) when compared to non-cancer MINOCA (2.3%/year, P=0.002) and in cancer MI-CAD (25.0%/year) versus non-cancer MI-CAD (3.7%/year, P<0.001). An active cancer (HR 3.12, 95%CI 2.41-4.04) was independently associated with a higher long-term mortality while higher hemoglobin levels (HR 0.93, 95%CI 0.88-0.99, per g/dl) and a MINOCA diagnosis (HR 0.69, 95%CI 0.47-0.97) improved long-term survival.
Conclusions: MINOCA were comorbid with cancer more frequently than MI-CAD. In turn, an active malignancy was associated with unfavorable long-term survival both in MI-CAD population as well as among MINOCA patients.