(P169) RISK FACTORS AND COMORBIDITIES ASSOCIATED WITH PREMATURE NON-OBSTRUCTIVE CORONARY ARTERY SYNDROMES IN WOMEN

Background: Myocardial infarction with no obstructive coronary arteries (MINOCA) and ischemia with no obstructive coronary arteries (INOCA) are heterogenous syndromes both characterized by < 50% obstruction on coronary angiography. Of note, INOCA has been observed to have approximately twice the prevalence in women (65%) than men (32%), and MINOCA three times higher in women presenting with MI (10.5%) than men (3.5%). These syndromes have been historically under-recognized, thus leading to an incomplete understanding of the diseases’ characteristics. Genetic influences on cardiovascular disease have been associated with premature onset (under 55 years old for women) relative to later-onset diagnoses, for which lifestyle and environment make relatively larger contributions. The aim of this exploratory study was thus to investigate any differences in variables co-occurring with incident MINOCA or INOCA in younger ( < 55) compared to older (≥55) presentations in women to provide insights into premature presentations.

METHODS AND RESULTS: This study was conducted using data collected from 207 women enrolled in the Leslie Diamond Women’s Heart Clinic Registry in Vancouver, British Columbia (n=140 INOCA, n=67 MINOCA). Proportions of premature INOCA (n=44, 31%) compared to MINOCA (n=28, 41%) were not significantly different (chi-squared p=0.19). Under a prospective observational registry study design, clinical variables were retrieved from electronic health records and physician consult notes. Table 1 summarizes baseline characteristics stratified by age and MINOCA or INOCA. Odds ratios and 95% CI for the associations were calculated using logistic regression for all variables and are visualized in figure 1. Variables significantly associated with increased odds of premature INOCA were a patient history of migraine (OR=2.25 (1.03-4.90), p=0.04) and Raynaud’s disease (OR=5.91 (1.80-23.00), p=0.005); and for premature MINOCA, a history of migraine (OR=3.93 (1.43-11.40), p=0.009) and a family history of premature cardiovascular disease in first degree relatives (OR=5.10 (1.61-18.40), p=0.01). Conversely, variables that were significantly associated with reduced odds of premature-onset INOCA were patient history of dyslipidemia (OR=0.38 (0.18-0.79), p=0.009), hypertension (OR=0.40 (0.19-0.83), p=0.02) and being a current or former (“ever”) smoker (OR=0.26 (0.06-0.82), p=0.04). Woolf’s chi-squared test of homogeneity of ORs demonstrated a significant difference in the impact of family history on premature CVD (p=0.03) between diagnoses.

Conclusion: Younger-onset MINOCA and INOCA are associated with different risk factors and comorbidities than later-onset MINOCA and INOCA. The differences in the magnitude and directionality of significant risk factors suggest potentially different etiologies contributing to younger onset MINOCA and INOCA compared to later onset, which warrants further investigation.