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Adherence to secondary preventive treatment following myocardial infarction with and without obstructive coronary

Anna M Nordenskjöld1, Miriam Qvarnström2, Björn Wettermark2

  • 1Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Plos One
|May 23, 2025
PubMed

Insights

Patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) showed lower adherence to secondary preventive medications compared to those with myocardial infarction with obstructive coronary arteries (MI-CAD). This suboptimal adherence in MINOCA patients may negatively impact their long-term prognosis.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Secondary preventive medications are crucial after myocardial infarction (MI) to reduce cardiovascular events.
  • Discontinuation and poor adherence to these medications are common, impacting patient outcomes.
  • Limited data exists on medication adherence specifically in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA).

Purpose of the Study:

  • To compare the adherence to guideline-recommended secondary preventive medications in patients diagnosed with MINOCA versus those with myocardial infarction with obstructive coronary arteries (MI-CAD).

Main Methods:

  • A nationwide observational study using the SWEDEHEART registry in Sweden (2006-2017).
  • Involved 9,138 MINOCA patients and 107,240 MI-CAD patients, followed for an average of 5.9 years.
  • Assessed medication initiation, implementation (medication possession ratio), and persistence rates over time.

Main Results:

  • MINOCA patients were prescribed secondary preventive medications less frequently than MI-CAD patients.
  • Adherence rates for aspirin, statins, ACEI/ARBs, and beta-blockers were consistently lower in MINOCA patients at multiple time points post-discharge compared to MI-CAD patients.
  • For example, at 12 months post-discharge, adherence to aspirin was 84.4% in MINOCA vs. 93.7% in MI-CAD.

Conclusions:

  • While medication initiation, implementation, and persistence were generally high in both groups, MINOCA patients exhibited lower adherence rates.
  • Potential reasons for lower adherence in MINOCA include diagnostic uncertainties, differing patient characteristics, and psychosocial factors.
  • Suboptimal adherence in MINOCA patients could potentially lead to adverse prognostic outcomes, similar to observed effects in MI-CAD patients.
Abstract

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