{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:59:59Z","timestamp":1785473999334,"version":"3.56.0"},"reference-count":24,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"crossref","award":["20190383"],"award-info":[{"award-number":["20190383"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003793","name":"Swedish Heart-Lung Foundation","doi-asserted-by":"crossref","award":["20210074"],"award-info":[{"award-number":["20210074"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"crossref"}]},{"award":["20190383"],"award-info":[{"award-number":["20190383"]}],"id":[{"id":"https:\/\/ror.org\/052261q33","id-type":"ROR","asserted-by":"publisher"}]},{"award":["20210074"],"award-info":[{"award-number":["20210074"]}],"id":[{"id":"https:\/\/ror.org\/052261q33","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The prognostic significance of myocardial infarction with non-obstructive coronary arteries (MINOCA) in older adults remains uncertain, particularly in comparison with revascularized acute coronary syndromes (ACS) and other acute myocardial injury phenotypes. Methods: In the prospective population-based cohort of the Malm\u00f6 Diet and Cancer Study (n = 30,466), 925 participants who experienced an incident coronary event between 2009 and 2018 were classified as revascularized ACS, MINOCA, or other acute myocardial injury phenotypes. All-cause mortality was assessed using Kaplan\u2013Meier estimates and Cox proportional-hazards models. Results: Of 925 patients (mean age, 81 \u00b1 7 years; female sex, 57%), 136 (14.7%) had a non-revascularized event, including 49 (36%) classified as MINOCA and 87 (64%) as other acute myocardial injuries. All non-revascularized cases underwent detailed review of angiographic and clinical records. During a median follow-up of 2.5 years, mortality was substantial across all groups (81%, overall). In unadjusted analyses, survival did not differ significantly among event categories (p = 0.302). In multivariable analysis, MINOCA was associated with increased mortality compared with revascularized ACS (aHR 1.48; 95% CI 1.07\u20132.05; p = 0.018) and with other acute myocardial injury phenotypes (aHR 1.44; 95% CI 1.01\u20132.04; p = 0.041). Other acute myocardial injury phenotypes did not differ significantly from revascularized ACS (aHR 1.03; 95% CI 0.78\u20131.35). Conclusions: MINOCA is associated with higher mortality than both revascularized ACS and other acute myocardial injury phenotypes. Despite the absence of obstructive coronary disease, MINOCA in later life carries an adverse prognosis and commands systematic diagnostic evaluation, careful phenotypic characterization, and appropriate risk-directed management.<\/jats:p>","DOI":"10.3390\/jcm15155917","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:13:47Z","timestamp":1785320027000},"page":"5917","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myocardial Infarction Without Obstructive Coronary Disease in Later Life: Insights from the Malm\u00f6 Diet and Cancer Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Behzad","family":"Banihashemi","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Lund University, 205 02 Malm\u00f6, Sweden"},{"name":"Department of Cardiology, Sk\u00e5ne University Hospital, 205 02 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1401-6623","authenticated-orcid":false,"given":"Fabrizio","family":"Ricci","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \u201cG.d\u2019Annunzio\u201d University of Chieti-Pescara, Via dei Vestini 33, 66100 Chieti, Italy"},{"name":"University Cardiology Division, Heart Department, SS. Annunziata Polyclinic, Via dei Vestini, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Intzilakis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sk\u00e5ne University Hospital, 205 02 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8475-0866","authenticated-orcid":false,"given":"Viktor","family":"Hamrefors","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University, 205 02 Malm\u00f6, Sweden"},{"name":"Department of Cardiology, Sk\u00e5ne University Hospital, 205 02 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Holm","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University, 205 02 Malm\u00f6, Sweden"},{"name":"Department of Cardiology, Sk\u00e5ne University Hospital, 205 02 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5352-6327","authenticated-orcid":false,"given":"Artur","family":"Fedorowski","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University, 205 02 Malm\u00f6, Sweden"},{"name":"Department of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden"},{"name":"Department of Medicine, Solna, Karolinska Institute, 171 76 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur. 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