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)

Abstract

BACKGROUND.Myocardial infarction with nonobstructive coronary arteries (MINOCA) has similar outcomes to patients with acute MI with obstructive coronary disease for up to 1 year. 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 non-obstructive coronary artery disease. OBJECTIVES In the present study, we aimed to compare the long-term preventive effect of DAPT to aspirin alone in high cardiovascular-risk patients over 5 years. METHODS For the long-term observation, 34 MINOCA patients with a high 10-year risk of atherosclerotic cardiovascular disease (ASCVD ≥20%) were randomly distributed among the DAPT group (15 patients on aspirin plus clopidogrel therapy) and the MAPT group (19 patients on aspirin alone). The decision about prolonged DAPT was made through the case-by-case evaluation of the bleeding and ischemic risks via the DAPT score calculator. RESULTS By Kaplan-Meier survival analysis, the mean survival time for the DAPT group (4.7±0.048 years 95% CI [4.60 to 4.79]) was significantly longer than the mean survival time for the APMT group (4.5±0.049 years 95% CI [4.41 to 4.61]), with p-value less than 0.0001. CONCLUSIONS Long-term dual antiplatelet therapy effectively and safely reduces major adverse cardiovascular and cerebrovascular events (MACCEs) in patients after myocardial infarction with nonobstructive coronary arteries (MINOCA). KEYWORDS Atherosclerotic cardiovascular disease (ASCVD) risk; dual antiplatelet therapy (DAPT); major adverse cardiovascular and cerebrovascular events (MACCEs); myocardial infarction with nonobstructive coronary artery (MINOCA) disease.