Impact of Mental Health Disorders in Patients with Myocardial Infarction with Non-obstructive Coronary Arteries: A Propensity Score–Matched Nationwide Analysis

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is defined by myocardial infarction criteria with < 50% stenosis and no clear cause. While mental health disorders are linked to cardiovascular risk, their impact on MINOCA outcomes is not well studied. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2017 to 2021, identifying hospitalized MINOCA patients with and without mental health disorders using ICD-10-CM codes. Propensity score matching and inverse probability weighting (IPW) were employed to adjust for confounders and balance baseline characteristics. Multivariable logistic regression estimated adjusted odds ratios and 95% confidence intervals for in-hospital outcomes. Results: Among 4300 propensity-matched pairs (8600 patients), MINOCA patients with mental health disorders had higher in-hospital mortality (2.26% vs 1.21%, p < 0.001) and increased risk of sudden cardiac arrest (1.51% vs 0.65%, p < 0.001). They were also more likely to develop pulmonary embolism (1.54% vs 0.65%, p < 0.001) and acute kidney injury (25.45% vs 20.24%, p < 0.001). Conclusion: Mental health disorders are independently associated with higher in-hospital mortality and adverse cardiovascular outcomes among MINOCA patients. These findings highlight the urgent need for integrated cardiovascular and psychiatric care, emphasizing early screening, multidisciplinary management, and targeted interventions to improve patient outcomes.