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

Wenjie Chen1,2, Yufeng Jiang1,2, Tan Chen1,2

  • 1Department of Cardiology, Dushu Lake Hospital Affiliated to Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, Jiangsu, China.

Frontiers in Cardiovascular Medicine
|January 26, 2023
PubMed

Insights

Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) may not benefit from standard heart attack treatments. Further research is needed to determine the best antiplatelet therapies for MINOCA based on its specific causes.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Clinical Research

Background:

  • Myocardial infarction with non-obstructive coronary arteries (MINOCA) presents a diagnostic and therapeutic challenge due to its heterogeneous nature.
  • Current secondary prevention strategies for obstructive coronary artery disease (MI-CAD) may not be directly applicable to MINOCA patients.
  • The underlying etiologies and pathophysiological mechanisms of MINOCA are diverse, influencing treatment responses.

Purpose of the Study:

  • To investigate the effectiveness and safety of antiplatelet agents in MINOCA patients.
  • To explore the impact of MINOCA etiology on treatment outcomes.
  • To guide the design of prospective studies clarifying MINOCA pathophysiology and treatment.

Main Methods:

  • Review of current observational data on antiplatelet therapy in MINOCA.
  • Proposal for prospective, randomized controlled trials (RCTs) focusing on MINOCA etiologies.
  • Assessment of antiplatelet agent specificity, efficacy, and safety in diverse MINOCA populations.

Main Results:

  • Observational studies currently do not demonstrate a clear benefit of antiplatelet therapy for MINOCA.
  • Etiology-specific responses to antiplatelet agents in MINOCA remain largely uncharacterized.
  • Optimal antiplatelet strategies for MINOCA require further investigation through RCTs.

Conclusions:

  • The efficacy of standard antiplatelet therapies in MINOCA is uncertain and likely dependent on the underlying cause.
  • Prospective RCTs are essential to establish evidence-based treatment guidelines for MINOCA.
  • Tailoring antiplatelet therapy to specific MINOCA etiologies is crucial for improving patient outcomes.

Keywords:
antiplatelet therapyatherosclerotic plaquecoronary artery disease non-obstructivedual antiplatelet therapymicrovascular diseasemyocardial infarction

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