Ten-Year Clinical Outcomes in MINOCA: A Clinical Framework for Long-Term Risk Stratification

Clinical Prognostic Score in Non-Obstructive Infarction

Abstract

Objective: This study aimed to design and validate myocardial infarction with non-obstructive coronary arteries (MINOCA), a practical bedside prognostic tool for evaluating the long-term risk profiles of patients experiencing myocardial infarction (MI) with MINOCAs.
Methods: A retrospective cohort analysis was carried out at Gazi University between January 2013 and December 2018. MINOCA was diagnosed based on standard biochemical and clinical MI criteria, alongside angiographic evidence of stenosis of <50% in the epicardial arteries. We extracted baseline clinical, laboratory, and echocardiographic data from electronic registries. The primary endpoint was major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular death, non-fatal MI, stroke, and hospitalization for heart failure; outcomes were tracked up to June 2025. Predictor variables were assessed via logistic regression, and the multivariable coefficients were used to assign point values for the PRO-MINOCA score. Statistical evaluations included receiver operating characteristic curves for discrimination, Kaplan-Meier survival curves, and Cox proportional hazards models for survival analysis.
Results: The cohort comprised 658 subjects (mean age 59.2 ± 11.6 years; 52.4% women). During the extended follow-up, 158 individuals (24%) experienced MACE. Multivariable analysis identified several independent risk factors: age ≥65 years, hypertension, diabetes, left ventricular ejection fraction (EF) <50%, estimated glomerular filtration rate <60 mL/min/1.73 m², elevated levels of C-reactive protein, troponin, and N-terminal pro-brain natriuretic peptide (NT-proBNP), incident atrial fibrillation, and a history of peripheral arterial disease, MI, or prior stroke. The formulated PRO-MINOCA scale (ranging from 0 to 12 points; higher scores indicate greater risk) allocated 2 points each to reduced EF and elevated NT-proBNP and 1 point to the other parameters. The score demonstrated strong discriminative capacity [area under the curve: 0.781; 95% confidence interval (CI): 0.745–0.816; p < 0.001]. A threshold of ≥7 provided 74% sensitivity and 70% specificity. Individuals scoring ≥7 exhibited a profoundly reduced event-free survival rate (log-rank χ²: 61.2; p < 0.001) and a more than twofold increase in MACE risk (hazard ratio: 2.67; 95% CI: 2.06-3.44).
CONCLUSION: The PRO-MINOCA score serves as a highly practical, purely clinical instrument that effectively identifies MINOCA patients who are at elevated long-term risk based on baseline diagnostic data. This tool can facilitate early, risk-adjusted management, particularly in environments lacking advanced cardiovascular imaging. Prospective and external validation studies are recommended.