Impact of obesity on cardiovascular outcomes in myocardial infarction with non-obstructive coronary arteries

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents a heterogeneous clinical entity with variable prognosis. The influence of obesity on cardiovascular outcomes in this population remains poorly defined, particularly across diverse global populations. Purpose: To evaluate the association between obesity and cardiovascular outcomes in patients with MINOCA using a global federated health research network. Methods: This retrospective cohort study utilized the TriNetX global health research network, incorporating data from multiple healthcare organizations across North America, Europe, and other regions. Patients diagnosed with MINOCA (ICD-10: I21.B) were stratified by the presence or absence of obesity. Propensity score matching (1:1) was performed to balance demographic and clinical characteristics. Outcomes assessed over 5 years included heart failure hospitalizations, stroke, atrial fibrillation, and allcause mortality. Hazard ratios (HRs), risk differences, and 95% confidence intervals (CIs) were calculated. Results: After matching, 516 patients were included (258 per group). There were no significant differences between obese and nonobese patients in heart failure hospitalizations (HR 0.79; 95% CI 0.35–1.79), stroke (HR 0.64; 95% CI 0.11–3.85), atrial fibrillation (HR 1.22; 95% CI 0.41–3.62), or all-cause mortality (HR 2.25; 95% CI 0.86–5.85). Kaplan–Meier analyses demonstrated similar event-free survival across all outcomes. Confidence intervals were wide, reflecting limited event rates. Conclusion: In this global propensity-matched cohort, obesity was not associated with increased risk of adverse cardiovascular outcomes in patients with MINOCA. These findings suggest that the prognostic impact of obesity in MINOCA may differ from that observed in obstructive coronary artery disease. However, the limited sample size and wide confidence intervals highlight the need for larger studies to better define the role of obesity in this population.