Antiplatelet therapy in patients with myocardial infarction with non-obstructive coronary arteries: A clinical perspective

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of diseases with different pathological mechanisms, and it is uncertain whether the classical secondary prevention and treatment strategies for myocardial infarction in obstructive coronary artery disease (MI-CAD) are appropriate for patients with MINOCA. Therefore the choice of antiplatelet agents and the therapeutic effect may vary depending on the etiology and pathophysiological mechanisms of MINOCA. This requires our clinical and scientific researchers to properly design prospective studies to explore the pathophysiology of MINOCA and its corresponding etiology in greater depth, so as to understand the effectiveness and safety of medical therapies for different etiologies of MINOCA. Although the current observational studies do not show an obvious beneficial effect of antiplatelet therapy on MINOCA. We are eager to conduct specific prospective randomized controlled trials of antiplatelet agents to assess the specificity, efficacy and safety of different types of antiplatelet agents in patients with MINOCA of different etiologies.

Comparison of Long-term Preventive Effects of Dual Antiplatelet Therapy vs. Monotherapy in High Cardiovascular Risk Patients After Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)

“…However, the efficacy of various antiplatelet therapy regimens for preventing MACCEs in individuals with nonobstructive coronary artery disease remains unclear. 14 According to existing evidence, dual antiplatelet therapy (DAPT) was not significantly better than aspirin alone in lowering 1-year MACCEs in different cardiovascular risk patients with NOCAD. [15][16][17][18] The same results were found in our recent cohort study of secondary prevention DAPT (aspirin plus the P2Y12 receptor antagonist clopidogrel) was not significantly better than aspirin alone in lowering 1-year MACCEs.…”

Antiplatelet Therapy for Secondary Prevention After Myocardial Infarction in Antiplatelet-Naive High Cardiovascular Risk Patients with Non-Obstructive Coronary Artery Disease

“…However, the effectiveness of different antiplatelet treatment regimens and secondary prevention strategies for patients with non-obstructive coronary artery disease is still uncertain. 11 Lindahl B et al reported a neutral benefit for dual antiplatelet therapy in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. 12 The ongoing multicenter, prospective, randomized, controlled, and open-label registry-based trial MINOCA-BAT will be answering the question about the usefulness of DAPT in MINOCA patients.…”