Pharmacological therapy for the prevention of cardiovascular events in patients with myocardial infarction with non-obstructed coronary arteries (MINOCA): Insights from a multicentre national registry

Ciliberti, Giuseppe; Verdoia, Monica; Merlo, Marco; Zilio, Filippo; Vatrano, Marco; Bianco, Francesco; Mancone, Massimo; Zaffalon, Denise; Bonci, Alessia; Boscutti, Andrea; Infusino, Fabio; Coiro, Stefano; Stronati, Giulia; Tritto, Isabella; Gioscia, Rocco; Russo, Antonio Dello; Fedele, Francesco; Gallina, Sabina; Cassadonte, F.; Ambrosio, Giuseppe; Bonmassari, Roberto; Luca, Giuseppe De; Sinagra, Gianfranco; Capucci, Alessandro; Kaski, Juan Carlos; Guerra, Federico

doi:10.1016/j.ijcard.2020.11.040

Cited by 51 publications

(45 citation statements)

References 30 publications

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“…A post hoc analysis of the CURRENT-OASIS 7 randomised trial comparing high dose versus standard dose of clopidogrel even indicated possible harm of high-dose clopidogrel in patients with MINOCA as opposed to in patients with MI-CAD 88 . In contrast, statin treatment has mostly been shown to be associated with lower mortality and a lower rate of MACE [83][84][85][86][87] , a relative decrease of the same level as was shown in randomised trials of secondary prevention with statins in MI patients 89 . Similarly, mostly positive results have been shown for angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) [83][84][85][86][87] .…”

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 87%

“…Except in SCAD, long-term low-dose aspirin is recommended for secondary prevention after MINOCA in recent consensus documents 4 . DAPT treatment is controversial, but has not been shown to be associated with lower risk in any observational study so far [83][84][85][86][87] . A post hoc analysis of the CURRENT-OASIS 7 randomised trial comparing high dose versus standard dose of clopidogrel even indicated possible harm of high-dose clopidogrel in patients with MINOCA as opposed to in patients with MI-CAD 88 .…”

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 98%

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Myocardial infarction with non-obstructive coronary artery disease

Lindahl¹,

Baron²,

Albertucci³

et al. 2021

EuroIntervention

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As a result of the increased use of coronary angiography in acute myocardial infarction in the last two decades, myocardial infarction with non-obstructive coronary arteries (MINOCA) has received growing attention in everyday clinical practice. At the same time, research interest in MINOCA has increased significantly. MINOCA is a heterogeneous disease entity seen in 5-10% of all patients with myocardial infarction, especially in women. Clinically, MINOCA may be difficult to distinguish from other non-ischaemic conditions that can cause similar symptoms and myocardial injury. There is still some confusion around the diagnosis, investigation and management of patients with MINOCA. The present review summarises the current knowledge of MINOCA regarding epidemiology, pathophysiology, investigation, and treatment, with a special focus on imaging modalities. In addition, remaining important knowledge gaps are highlighted. KEYWORDS • clinical research • miscellaneous • risk stratificationEuroIntervention 2021;17:e875-e887 e 876 Abbreviations ACEI angiotensin-converting enzyme inhibitors ACS acute coronary syndromes ARB angiotensin receptor blockers CAD coronary artery disease CMD coronary microvascular disease CMR cardiac magnetic resonance imaging CT computed tomography CTCA computed tomography coronary angiography DAPT dual antiplatelet treatment IVUS intravascular ultrasound MACE major adverse cardiac events MI myocardial infarction MI-CAD myocardial infarction -coronary artery disease with significant stenosis MINOCA myocardial infarction with non-obstructive coronary arteries OCT optical coherence tomography PCI percutaneous coronary intervention PET positron emission tomography SCAD spontaneous coronary artery dissection

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Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 87%

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 98%

Myocardial infarction with non-obstructive coronary artery disease

Lindahl¹,

Baron²,

Albertucci³

et al. 2021

EuroIntervention

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“…Still, in the reperfusion era, the benefit of BB treatment in patients with MI-CAD and preserved LVEF is controversial and the role for BB in patients with MINOCA is unknown [ 12 ]. In a retrospective multicenter Italian study of patients with MINOCA, BB use was associated with a reduction in acute coronary syndrome, heart failure hospitalization, stroke, or death [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Variability of discharge medical therapy for secondary prevention among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) in the United States

et al. 2021

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Background Optimal medical therapy after myocardial infarction with nonobstructive coronary arteries (MINOCA; <50% stenosis) is uncertain. We evaluated variability in discharge prescription of angiotensin-converting enzyme inhibitors / angiotensin receptor blockers (ACEI/ARB) and beta-blockers (BB) to MINOCA patients between hospitals to assess physician equipoise about secondary prevention. Methods Patients with MINOCA between 2007–2014 were identified in the NCDR Chest Pain–MI Registry. Those with prior revascularization or missing demographic, angiographic, or medication data were excluded. Analysis was limited to high-volume hospitals with ≥20 MINOCA total discharges. Discharge prescriptions for ACEI/ARB and BB after MINOCA were analyzed for each hospital. Clinical data on left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and diabetes mellitus status were extracted to identify other indications for ACEI/ARB or BB. Results Clinical data were available for 17,849 MINOCA patients, of whom 8,752 (49%) had LVEF <40%, GFR ≤60 mL/min, and/or diabetes. 5,913 patients without one of these indications for ACEI/ARB or BB were discharged from 156 high-volume hospitals. At discharge, ACEI/ARB was prescribed to between 16.0% and 88.8% of MINOCA patients (median 45.6%, IQR 38.0%-56.5%) and BB to between 28.0% and 97.5% (median 74.1%, IQR 64.7%-80.0%). Conclusion There is marked variability between hospitals in the proportions of patients receiving ACEI/ARB and BB after hospitalization for MINOCA, suggesting clinical equipoise about the routine use of these agents. Randomized clinical trials are necessary to establish the benefit of ACEI/ARB and BB to improve outcomes after MINOCA.

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“…A recent retrospective multicenter cohort study in Italy found that standard therapy for secondary prevention of MINOCA may not be beneficial, and may even be detrimental in some subgroups. During a median follow-up of 8.5 years, beta-blockers demonstrated a significant reduction of MACE whereas aspirin was found to be significantly associated with an increased risk of MACE [ 94 ]. Conversely, Lindahl.…”

Section: Unknown Etiologymentioning

confidence: 99%