Clinical characteristics and long-term outcomes of MINOCA accompanied active cancer: A retrospective insight into a cardio-oncology centre registry

• There is minimal evidence representing the clinical characteristics and long-term outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and cancer
• This study aimed to distinguish these patients hospitalised in a tertiary cardio-oncology centre and to find the potential factors influencing their long-term mortality
• This study is the first to report comprehensive data pooled from a tertiary cardio-oncology centre on the association between cancer and MINOCA and its effect on long-term clinical outcomes. These data provide evidence that active cancer in the patients with MI, overrepresented among the MINOCA population, and was significantly and independently associated with unfavourable long-term survival

Retrospectively, 1,011 patients in a tertiary cardio-oncology centre went through coronary angiography due to the diagnosis of myocardial infarction (MI) based on clinical symptoms, electrocardiographic findings, and the evolution of myocardial necrotic biomarkers. MINOCA was diagnosed in 72 of patients and 134 of patients were identified with active cancer. Patients clinical and laboratory characteristics data was gathered. The information on the length of hospitalisation and long-term all-cause mortality was collected from hospital records and National Health Registry, respectively.

• Patients with MI who underwent coronary angiography and were hospitalised in a tertiary cardio-oncology centre (2012–2017)  
• Lack of obstructive lesions narrowing epicardial coronary segments by > 50% in angiography

• Active cancer was identified more frequently in MINOCA patients than those with myocardial infarction and obstructive coronary artery disease (MI-CAD)  (29.2 vs. 12.0%; p < 0.001)
• Among MINOCA patients, those with cancer vs. non-cancer MINOCA, had a higher incidence of anaemia (47.6 vs. 21.6%; p = 0.03) and Takotsubo syndrome (19.1 vs. 2.0%; p = 0.01)
• Compared with their respective non-cancer patients, those with cancer MINOCA and MI-CAD had a higher troponin T/haemoglobin ratio (p < 0.05)
• The age and sex-standardised mortality rates were significantly higher in cancer MINOCA vs. non-cancer MINOCA (26.7% vs. 2.3% per year; p = 0.002) and in cancer MI-CAD vs.
• non-cancer MI-CAD (25.0% vs. 3.7%/year; p < 0.001).
• Active cancer (hazard ratio [HR], 3.12; 95% confidence interval [CI], 2.41–4.04) was linked with higher long-term mortality, whereas higher haemoglobin 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) were shown to improve long-term survival

Patients with MINOCA had higher rates of being comorbid with cancer compared with MI-CAD. However, an active malignancy was associated with a decreased long-term survival in both treatment arms

• The cancer MINOCA group was relatively small
• Due to the small sample size of patients with different types of cancer, a multivariable analysis had to be performed for all patients with cancer
• Cardiac magnetic resonance and intracoronary imaging were not performed to confirm an alternative diagnosis
• Apart from death, other clinical outcomes were not analysed
• Specific coagulation tests that would determine the role of prothrombotic states involved in the aetiology of MINOCA were not performed