Antiplatelet Therapy for Secondary Prevention After Myocardial Infarction in Antiplatelet-Naive High Cardiovascular Risk Patients with Non-Obstructive Coronary Artery Disease

Abstract

BACKGROUND.The growing evidence indicates the importance of non-obstructive coronary artery disease (NOCAD), with a high-risk of MACEs. The relevance of antiplatelet therapy is high and depends on a type of MINOCA. However, the effectiveness of different antiplatelet treatment regimens and secondary prevention strategies for patients with non-obstructive coronary artery disease is still unclear. OBJECTIVES In our previous cohort study, we found that secondary prevention with dual antiplatelet therapy with aspirin and P2Y12 receptor antagonist clopidogrel in patients with NOCAD was not significantly effective than aspirin alone in reducing 1-year MACEs. Because the development and validation cohorts of patients with NOCAD were heterogeneous in terms of cardiovascular risk, in the current study we aimed to compare the preventive effect of DAPT with aspirin alone in high cardiovascular-risk patients. METHODS Following the aim of our study, we selected 15 of 55 MINOCA patients with a high 10-year risk for ASCVD (≥20%) from the DAPT group and 19 of 60 patients with the same risk from the no-DAPT group. RESULTSThe results of our previous and present studies corroborate previously published data. DAPT had no secondary preventive effect on one-year MACE in MINOCA patients with different cardiovascular risks. CONCLUSIONS The use of DAPT in patients with MINOCA is a topic for discussion and requires further investigations with a long-term follow-up period. KEYWORDS Atherosclerotic cardiovascular disease (ASCVD) risk; dual antiplatelet therapy (DAPT); myocardial infarction with non-0bstructive coronary artery (MINOCA) disease; non-obstructive coronary disease (NOCAD).

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)

“…[15][16][17][18]27 Our prior research results support previously published data on the lack of a secondary preventative effect of DAPT on one-year MACE in MINOCA patients with different cardiovascular risks. 19,28 Pending trial evidence about the usefulness of DAPT in MINOCA patients from ongoing MINOCA-BAT trial, 29 we decided to compare the long-term preventive effect of dual antiplatelet therapy with a monotherapy regimen in high cardiovascular risk (10-year ASCVD ≥20%) MINOCA patients.…”

“…Our previous study showed that DAPT had no secondary preventive effect on one-year cumulative MACCEs in MINOCA patients with high cardiovascular risks. 19 The neutral effect of dual antiplatelet therapy was observed during the second follow-up year; however, from the third year until the end of the follow-up, the preventive effect of DAPT on cumulative MACCEs significantly exceeded the effect of antiplatelet monotherapy with aspirin.…”

“…[15][16][17][18] The same results were found in our recent cohort study of secondary prevention DAPT (aspirin plus the P2Y12 receptor antagonist clopidogrel) was not significantly better than aspirin alone in lowering 1-year MACCEs. 19 ABSTRACT M DOI: 10.52340/GBMN.2023.01.01.31…”

Role of Vasoactive Hormone-Induced Signal Transduction in Cardiac Hypertrophy and Heart Failure

“…Several antiplatelet agents such as aspirin, clopidogrel and cilostazol, either alone or in combination, have been reported to produce beneficial effects in diverse cardiovascular dis-eases including pulmonary hypertension [157,158], coronary artery abnormalities [159][160][161][162][163] and ventricular arrhythmias and atrial fibrillation [155,156,164]. Furthermore, the 5-HT 2A receptor antagonist, ketanserin, has been shown to improve hemodynamic and neurohumoral alterations in patients with heart failure [165,166].…”