Mental illness linked to worse heart attack outcomes in surprise finding

<p><strong>Background</strong>: Knowledge on the influence of mental disorders and unfavourable sociodemographic factors in patients experiencing myocardial infarction with non-obstructive coronary arteries (MINOCA) remains limited. We investigated the prevalence of mental disorders, psychotropic drug dispensation, and sociodemographic factors in patients with MINOCA and MI with coronary artery disease (MI-CAD) and assessed their association with prognosis.</p><p><strong>Methods and results</strong>: In this nationwide register-based cohort study of 8367 MINOCA and 109,059 MI-CAD patients, mental disorders (4.3% vs 2.6%, p &lt; 0.001) and psychotropic drug dispensation (26.1% vs 17.4%, p &lt; 0.001) were more frequent in MINOCA, particularly female patients. MINOCA patients were also more often divorced (21.1% vs 19.7%, p &lt; 0.001), widowed (6.8% vs 4.9%, p &lt; 0.001), or on sick leave (4.4% vs 3.2%, p &lt; 0.001). Over a median 5.5-year follow-up, a major adverse cardiovascular event (MACE) occurred in 25.5% of MINOCA and 27.8% of MI-CAD patients (p &lt; 0.001). Adjusted analyses showed that mental disorders and dispensed psychotropic drugs independently predicted MACE in both MINOCA (HR 1.27; 95% CI 1.15-1.40) and MI-CAD (HR 1.35; 95% CI 1.31-1.39).</p><p><strong>Conclusion</strong>: Mental disorders and psychotropic drug dispensation were more common in MINOCA than MI-CAD, particularly in female patients. Unfavourable sociodemographic factors were common in both groups, with a modest excess in MINOCA. The association between mental health variables and adverse outcomes in both conditions suggests shared mechanisms beyond traditional cardiovascular risk factors.</p>