BACKGROUND.The growing evidence indicates the importance of non-obstructive coronary artery disease (NOCAD), with a high-risk of MACEs. The relevance of antiplatelet therapy is high and depends on a type of MINOCA. However, the effectiveness of different antiplatelet treatment regimens and secondary prevention strategies for patients with non-obstructive coronary artery disease is still unclear. OBJECTIVES In our previous cohort study, we found that secondary prevention with dual antiplatelet therapy with aspirin and P2Y12 receptor antagonist clopidogrel in patients with NOCAD was not significantly effective than aspirin alone in reducing 1-year MACEs. Because the development and validation cohorts of patients with NOCAD were heterogeneous in terms of cardiovascular risk, in the current study we aimed to compare the preventive effect of DAPT with aspirin alone in high cardiovascular-risk patients. METHODS Following the aim of our study, we selected 15 of 55 MINOCA patients with a high 10-year risk for ASCVD (≥20%) from the DAPT group and 19 of 60 patients with the same risk from the no-DAPT group. RESULTSThe results of our previous and present studies corroborate previously published data. DAPT had no secondary preventive effect on one-year MACE in MINOCA patients with different cardiovascular risks. CONCLUSIONS The use of DAPT in patients with MINOCA is a topic for discussion and requires further investigations with a long-term follow-up period. KEYWORDS Atherosclerotic cardiovascular disease (ASCVD) risk; dual antiplatelet therapy (DAPT); myocardial infarction with non-0bstructive coronary artery (MINOCA) disease; non-obstructive coronary disease (NOCAD).

BACKGROUND.Myocardial infarction with non-obstructive coronary artery disease (MINOCA) accounts for 5-20% of all cases of myocardial infarction. The growing evidence indicates the importance of oxidative stress and chronic inflammation in the heterogenous pathophysiology of MINOCA. OBJECTIVES In the present study, we aimed to evaluate oxidative and inflammatory statuses in patients with MINOCA and compare them with the same indices of patients with obstructive coronary disease non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS Overall, 165 of 1018 patients admitted to the Coronary Care Unit of Tsinamdzgvrishvili Center of Cardiology LTD (Tbilisi, Georgia) because of the first episode of acute coronary syndrome (ACS) was divided into two groups: 115 patients with MINOCA were distributed into the group 1, and 50 patients with obstructive coronary disease NSTE-ACS into the group 2. Oxidative stress and inflammatory markers were evaluated in study patients. RESULTSWe found an increase in free radical concentrations in both groups of study patients, but there was no difference in the mean amount of overall organic radicals (FORT)(p=0.412). We also found a significantly lower mean concentration of plasmatic antioxidant compounds (FORD) in patients with MINOCA (p=0.036) compared with NSTE-ACS patients, indicating a more pronounced depletion of antioxidant potential in MINOCA patients. The results of admission inflammatory markers, such as hs-CRP and hemogram-derived NLR, suggest significantly higher inflammatory status in MINOCA patients than in those with NSTE-ACS. CONCLUSIONSThe results of the present study emphasize the significance of oxidative stress and inflammation in the pathogenesis of MINOCA. KEYWORDS Free Oxygen Radical Defense (FORD); Free Oxygen Radical Test (FORT); Myocardial infarction with non-obstructive coronary artery disease (MINOCA); Oxidative profile; Oxidative stress; Oxidative-reductive balance (REDOX index).