Health related quality of life and cardiac symptoms following admission for suspected MINOCA: A post-hoc analysis of the MINOCA-BAT randomized clinical trial

BACKGROUND: Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) accounts for 6-8% of all MIs and is more common in women than men. After an episode of MINOCA, patients may experience a substantial symptom burden and reduced health-related quality of life (HRQoL). The aim of this post-hoc analysis was to describe clinical characteristics, residual symptoms and HRQoL, including sex differences in patients with a working diagnosis of MINOCA and preserved left ventricular ejection fraction (LV-EF). METHODS: Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment in MINOCA patients (MINOCA-BAT) was an international clinical trial. Patients with a working diagnosis of MINOCA and LV-EF ≥ 40% were randomized to beta-blocker versus no beta-blocker and ACEI/ARB versus no ACEI/ARB. The trial was prematurely terminated after 192 enrolled participants (median age 59; 63% women). Clinical events, symptoms and HRQoL (EQ-5D-3L) were assessed at 7 weeks and 12 months after the index event. RESULTS: The cohort represented a low-risk population. At one year, one patient had died, one had a re-infarction, 14% reported chest pain and 9% dyspnea. Median EQ-5D index scores did not change significantly between 7 weeks and 12 months (0.86 vs. 0.78) and were comparable to age-matched general population norms. Women reported slightly lower HRQoL than men. CONCLUSIONS: Patients with a working diagnosis of MINOCA and preserved LV-EF constitute a low-risk population and demonstrate a favorable prognosis with symptom resolution within one year. Their HRQoL appears broadly similar to that observed in the general population, with only modest differences between the sexes.