Insomnia in patients with myocardial infarction with and without obstructive coronary arteries: prevalence and prognosis

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Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology. Introduction Although some studies suggest a relationship between insomnia and cardiovascular disease, the initial approach of patients with myocardial infarction does not usually include the evaluation of sleep disorders as a contributing factor to cardiovascular disease. This study aims to compare the prevalence of insomnia between patients with obstructive coronary artery disease (MICAD) and those without significant coronary obstruction (MINOCA) and its impact on prognosis. Methods During a five-year period (July 2017-July 2022), all consecutive patients with myocardial infarction and coronarography were included. This study was conducted in a university hospital which covers a population of 220,000 people. Insomnia severity index (ISI) questionnaire was completed by each patient during admission. Follow-up analysis included major adverse cardiovascular events (MACE: cardiovascular readmission, myocardial reinfarction, stroke, and death from any cause). Results Among 533 patients, 56 had MINOCA, and 477 had MICAD. There were no significant differences in the prevalence of insomnia between both groups: insomnia median value (M) in MINOCA: M=7 (3-11) vs MICAD M=7 (3-12), p=0.95. Analysing it by sex, the score remained similar: MINOCA women M=9 (3.5-11.5) vs MICAD M=8.5 (3.2-15), p=0.6. MINOCA men M=5.5 (3-9.7) vs MICAD M=7 (3-11), p=0.77. (Figure 1)- At the three-year follow-up, there was a relationship between the insomnia levels and survival (IC [1.1-6.6], p=0.03). When ISI score was over 7 points (subclinical insomnia, moderate insomnia, or severe insomnia) there was a relationship with more mortality: number of events under the median value =7; number of events over the median value =16; (IC [1.1-6.6], p=0.03); whereas MACE remained similar (IC [0.6-1.5], p=0.89). Conclusions In this study, the prevalence of insomnia was similar between MINOCA and MICAD patients. A higher score in the ISI questionnaire was related to a worse prognosis at the three-year follow-up.

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