Familial risk of myocardial infarction with non-obstructive and obstructive coronary arteries -A nation-wide cohort study

Felicia H K Hakansson; Per Svensson; Hans J Pettersson; Ewa Ehrenborg; Jonas Spaak; Anna M Nordenskjold; Kai M Eggers; Per Tornvall

doi:10.1093/eurjpc/zwae313

Familial risk of myocardial infarction with non-obstructive and obstructive coronary arteries -A nation-wide cohort study

Eur J Prev Cardiol. 2024 Oct 7:zwae313. doi: 10.1093/eurjpc/zwae313. Online ahead of print.

Authors

Felicia H K Hakansson^{1

2}, Per Svensson^{1

2}, Hans J Pettersson^{1

2}, Ewa Ehrenborg³, Jonas Spaak⁴, Anna M Nordenskjold⁵, Kai M Eggers⁶, Per Tornvall^{1

2}

Affiliations

¹ Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
² Department of Cardiology Södersjukhuset, Stockholm, Sweden.
³ Division of Cardiovascular Medicine, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Cardiology and Clinical Science and Education Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁶ Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.

PMID: 39373562
DOI: 10.1093/eurjpc/zwae313

Abstract

Background and aims: The familial risk among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is unknown. Previous studies of family history in myocardial infarction (MI), have not made a distinction between MINOCA and MI due to coronary artery disease (MI-CAD), based on angiographic findings. We therefore sought to investigate familial risk of MI without and with obstructive coronary arteries.

Methods: Register-based cohort study with a total of 15,462 MINOCA cases, 204,424 MI-CAD cases, 38,220 control subjects without MI and with non-obstructive coronary arteries. First-degree relatives were identified 1995-2020. Cox proportional hazard regression models were used to compare familial risk in MINOCA and MI-CAD with control subjects.

Results: During a mean follow-up of 8.1 ± 4.2 years, MINOCA occurred in 1.0% of first-degree relatives with MINOCA whereas MI-CAD occurred in 9.7% of first-degree relatives of MINOCA. The age- and sex-adjusted hazard ratio (HR) for a MINOCA-relative experiencing MINOCA and MI-CAD, compared to control subjects, was 0.99 (95% confidence interval [CI] 0.80-1.23) and 1.10 (95% CI 1.03-1.18), respectively. During a mean follow-up of 8.5 ±4.8 years, MI-CAD occurred in 12.2% of first- degree relatives with MI-CAD with age- and sex-adjusted HR 1.43 (95% CI 1.37-1.49).

Conclusions: No increased familial risk of MINOCA was observed for MINOCA-patients whereas there was an increased familial risk for MI-CAD when compared to control subjects. These results may indicate that genetic factors and shared environmental factors within a family leading to CAD are important also for MINOCA, thus MI-CAD and MINOCA could share underlying mechanisms.

Keywords: MI-CAD; MINOCA; coronary angiography; familial risk.

Plain language summary

It is unknown whether a familial risk of myocardial infarction is important for developing myocardial infarction without obstructive coronary arteries (MINOCA). In our study we observed an increased familial occurrence for myocardial infarction with obstructive coronary artery disease (MI-CAD) when compared to control subjects whereas no increased familial occurrence of MINOCA was seen among MINOCA patients. These results may indicate that genetic factors and shared environmental factors within a family leading to CAD are important also for MINOCA, thus MI-CAD and MINOCA could share underlying mechanisms.