Methods
We retrospectively screened and analyzed all patients who were admitted to our hospital under the suspicion of an acute coronary syndrome within a 12-month period (2017 - 2018) for further diagnostics and treatment. All included patients showed a pathological troponin elevation and received invasive coronary angiography. Associated costs, procedural and various clinical parameters as well as timelines and parameters of work – flow were obtained.

Results
Altogether, 3021 patients were initially screened and 660 were included. Of those, 103 patients were attributed to the MINOCA – group. 542 patients presented with a "classical" myocardial infarction, and thus formed the MIOCA (myocardial infarction with obstructive coronary arteries) group. Baseline characteristics were summarized in table 1 and arranged according to the different entities of infarction. MINOCA patients were less frail, less diabetic, more likely female and showed no relevant difference in age or other selected comorbidities. The emergency department was the primary point and most common mode of hospital admission for > 70% of the patients from both groups. Approximately 50% of the patients arrived in the afternoon but still within regular working hours on a weekday. MINOCA patients were less present during the weekend as MIOCA patients (8.5 % vs. 19.7%; p = 0.002). With regard to a potential seasonal occurrence of these entities, both MINOCA and MIOCA cases show a pattern with two peaks (Figure 1). In - hospital mortality (MIOCA vs. MINOCA: 59 (11.1%) vs. 0 (0%) patients; p < 0.001), and 30 – day mortality (MIOCA vs. MINOCA: 94 (17.3%) vs. 5 (4.2%) patients; p < 0.001) after the clinical index event were significantly higher in the "classical" myocardial infarction group (MIOCA). MINOCA patients were more likely to receive coronary angiography later after admission (44.6 ± 78.6 h vs. 25.4 ± 69.5h; p = 0.014). Conversely, overall length of hospital stay (9.5 ± 8.7 days vs. 12.5 ± 12.7 days; p= 0.005) as well as mean duration of high care monitoring (ICU, IMC, CCU) (2.4 ± 4.6 days vs. 4.7 ± 7.7 days; p= 0.006) were shorter in the MINOCA group compared to MIOCAs. With an average of 6871.5 ± 5670.8 EUR per index, MINOCA treatment costs were lower compared to the real myocardial infarction group (14277.5 ± 7896.9 EUR; p < 0.001) with a mean difference of approximately 7406 EUR.

Conclusion
Despite MINOCA being mostly a benign syndrome with favorable clinical outcome, it still utilizes relevant financial and capacity resources including high care monitoring and an in - hospital treatment of relevant length. Regarding scarcity of resources, this entity should be put under particular consideration for identifying patients at an early stage during hospital admission and refining care concepts.