Statin therapy improves long-term survival in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA)

BACKGROUND: Current guidelines suggest that statins may be beneficial in patients with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). However, the available data are ambiguous. OBJECTIVES: We sought to investigate the effect of statin therapy on long-term mortality among MINOCA patients. MATERIAL AND METHODS: Between 2012 and 2019, coronary angiography was performed in 1,011 patients hospitalized with a diagnosis of MI. Patients with lesions narrowing coronary arteries by less than 50% were classified as MINOCA. Baseline clinical characteristics, laboratory and echocardiographic parameters, statin type prescribed at discharge, as well as long-term all-cause mortality were collected in the MINOCA group. RESULTS: MINOCA was diagnosed in 77 (7.6%) patients, while statins were prescribed in 57 (74%) of them at discharge. Subjects treated with statins had a higher prevalence of hypertension (94.7 vs 70%, p = 0.008) and dyslipidemia (77.2 vs 45%, p = 0.008), had a higher body mass index (BMI; p = 0.028), and were less likely to suffer from active cancer (17.5 vs 55.0%, p = 0.001). In multivariable logistic regression, active cancer independently reduced (odds ratio (OR) = 0.143, 95% confidence interval (95% CI): 0.027-0.748), whereas higher baseline low-density lipoorotein cholesterol (LDL-C) (OR = 3.216, 95% CI: 1.192-8.686) independently increased the likelihood of statin prescription at discharge. In the median follow-up of 69.2 [interquartile range (IQR): 37.8-79.9] months, all-cause mortality was significantly higher in MINOCA patients not treated with statins (p = 0.025). CONCLUSIONS: Roughly 75% of MINOCA patients were treated with statins at discharge. This decision was independently influenced by clinical characteristics and lipid profile. Statin prescription was associated with lower long-term all-cause mortality.