Sex influence on in-hospital and long-term prognosis of myocardial infarction with non-obstructive coronary artery disease. A systematic review and meta-analysis.

AIMS

The incidence of myocardial infarction with non-obstructive coronary artery disease (MINOCA) is higher in women than in men, but sex influence on prognosis is unclear. The aim of this study was to evaluate overall mortality and different major adverse cardiovascular events (MACE) during hospitalization and at follow-up in men and women with MINOCA.

METHODS

Prospective and retrospective studies reporting on the association between sex and adverse clinical outcomes in MINOCA patients were eligible. In-hospital and at follow-up outcomes in the overall pooled populations and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Fifteen studies, encompassing 42,870 patients (62.0 [3.7] years, 25,172 females [58.7%]), were included. A total of 277 patients died during hospitalization, and 2,236 deaths occurred during a mean follow-up of 3.5 (0.9) years. Pooled analyses demonstrated no sex differences in in-hospital mortality (OR, 1.05, 95%CI, 0.82-1.34, I2 = 0%) or all-cause death at follow-up (OR, 0.93, 95%CI, 0.76-1.13; I2 = 54%). In the long term, men had lower risk of non-fatal stroke (OR: 0.77, 95%CI: 0.60-0.99; I2 = 0%) but no significant sex differences were detected for other MACE. In women, MINOCA had a lower risk of in-hospital mortality than MI due to coronary artery disease (MI-CAD; OR, 0.39; 95%CI, 0.21-0.72; I² = 70%) while no relevant differences were found in males.

CONCLUSIONS

Sex does not seem to influence MINOCA prognosis, except for a higher incidence of stroke during follow-up found in women. In females, MINOCA has lower in-hospital mortality than MI-CAD.