Patients whose heart attacks occur without any blocked coronary artery appear to carry a measurably lighter inflammatory load on arrival at hospital than patients whose attacks stem from obstructive coronary disease, according to a multicenter retrospective observational study published in BMC Cardiovascular Disorders. The researchers used a composite measure called the admission inflammatory burden index, or IBI, calculated by multiplying high-sensitivity C-reactive protein by the neutrophil-to-lymphocyte ratio, and found that lower values were associated with the non-obstructive phenotype known as MINOCA.
This multicenter retrospective observational study screened 5,746 patients with acute myocardial infarction undergoing coronary angiography. The final cohort included 247 patients with MINOCA after clinical, angiographic, and cardiac magnetic resonance evaluation, alongside a computer-generated random sample of 525 patients with myocardial infarction with obstructive coronary artery disease (MICAD).
The association between systemic inflammatory burden and MINOCA had remained unclear before this work. The association between systemic inflammatory burden and MINOCA remained unclear, and the study evaluated this association using the admission IBI. IBI levels were indeed lower in patients with MINOCA than in those with MICAD, a difference that reached statistical significance with a P value below 0.001.
In logistic regression analyses, lower IBI was associated with the MINOCA phenotype. In unadjusted logistic regression, lower IBI was associated with the MINOCA phenotype with an odds ratio of 0.599 and a 95 percent confidence interval of 0.527 to 0.678, with P below 0.001. After multivariable adjustment, the association persisted, though attenuated, with an odds ratio of 0.813, a 95 percent confidence interval of 0.697 to 0.949, and a P value of 0.009. The association was attenuated after multivariable adjustment compared with the unadjusted analysis.
Restricted cubic spline analysis added a nonlinear dimension to the finding, showing an overall association with P below 0.001 and a P value for nonlinearity below 0.001, meaning the relationship between IBI and the MINOCA phenotype was not a simple straight-line effect. Quartile analysis, which divided patients into four groups by IBI level, showed attenuation in the highest quartile, with a P value for trend of 0.047. The authors reported that the findings were generally consistent across predefined subgroup and sensitivity analyses, suggesting the result is robust to different ways of slicing the data.
The authors themselves framed the conclusions cautiously. Lower admission IBI was associated with the MINOCA phenotype, they wrote, and these findings indicate differences in admission inflammatory burden between myocardial infarction phenotypes and should be considered hypothesis-generating. The authors stated that these findings indicate differences in admission inflammatory burden between myocardial infarction phenotypes and should be considered hypothesis-generating.
Subject of Research: Association between admission inflammatory burden index and myocardial infarction with non-obstructive versus obstructive coronary arteries
Article Title: Admission inflammatory burden index in myocardial infarction with non-obstructive versus obstructive coronary arteries: a multicenter observational study
Article References: Xu, C., Xu, C., Gu, P., Chen, W., Wang, T., Li, D., Zhang, J., Liu, T., Zhang, Q., Jing, Z., Ding, J., & Xue, Z. (2026). Admission inflammatory burden index in myocardial infarction with non-obstructive versus obstructive coronary arteries: a multicenter observational study. BMC Cardiovascular Disorders. https://doi.org/10.1186/s12872-026-06935-x
Image Credits: AI Generated
DOI: 10.1186/s12872-026-06935-x
Keywords: MINOCA, inflammatory burden index, C-reactive protein, neutrophil-to-lymphocyte ratio, coronary angiography, cardiac magnetic resonance, multicenter observational study, logistic regression, restricted cubic spline, acute myocardial infarction, Admission, inflammatory
News Source: Ophelia Keating. (October 30, 2026). Inflammatory burden at admission runs lower in heart attacks with unblocked arteries, multicenter study finds. Scienmag.
