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Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Myocardial Infarction With Nonobstructive Coronary

Ioannis Efthymiou1, Sotirios Chiotis2, Christina Vlachvei3

  • 1From the Department of Cardiology, "Papanikolaou" General Hospital, Thessaloniki, Greece.

Cardiology in Review
|April 4, 2025
PubMed

Insights

Dual antiplatelet therapy (DAPT) may reduce major adverse cardiovascular events (MACE) in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA). However, current evidence is not statistically significant, necessitating further research to confirm DAPT

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Myocardial infarction with nonobstructive coronary arteries (MINOCA) presents diagnostic and prognostic challenges.
  • The efficacy of dual antiplatelet therapy (DAPT) for secondary prevention in MINOCA is not well-established.
  • Existing guidelines for traditional myocardial infarction may not directly apply to MINOCA management.

Purpose of the Study:

  • To systematically review and meta-analyze the existing literature on the use of DAPT in MINOCA patients.
  • To evaluate the impact of DAPT on major adverse cardiovascular events (MACE) in this specific patient population.
  • To determine the current evidence base for DAPT in MINOCA secondary prevention.

Main Methods:

  • Systematic literature search of PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2024.
  • Inclusion of cohort studies reporting MACE in MINOCA patients treated with DAPT.
  • Meta-analysis performed using a random-effects model (DerSimonian and Laird).

Main Results:

  • Seven studies comprising 12,307 MINOCA patients were included in the meta-analysis.
  • A trend towards a reduced risk of MACE was observed in patients receiving DAPT (pooled hazard ratio: 0.82; 95% CI: 0.66-1.03).
  • This trend did not reach statistical significance, indicating inconclusive results.

Conclusions:

  • DAPT may offer potential benefits in reducing MACE for MINOCA patients.
  • The current evidence is insufficient to definitively establish the role of DAPT in MINOCA secondary prevention.
  • Further randomized controlled trials are required to confirm these findings and guide clinical practice.

Keywords:
MINOCAdual antiplatelet therapymeta-analysismyocardial infarctionnonobstructive coronary arteriessecondary prevention

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