Comparison of Patients With Nonobstructive Coronary Artery Disease With Versus Without Myocardial Infarction (from the VA Clinical Assessment Reporting and Tracking [CART] Program)

Kovach, Christopher P.; Hebbe, Annika; O’Donnell, Colin; Plomondon, Mary E.; Hess, Paul L.; Rahman, Aref; Mulukutla, Suresh; Waldo, Stephen W.; Valle, Javier A.

doi:10.1016/j.amjcard.2021.01.015

Cited by 12 publications

(16 citation statements)

References 31 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: 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] . On the other hand, most studies on beta-blockers have not found significant association with outcome [83][84][85][86][87] .…”

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 88%

“…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: 99%

“…Similarly, mostly positive results have been shown for angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) [83][84][85][86][87] . On the other hand, most studies on beta-blockers have not found significant association with outcome [83][84][85][86][87] . In the large study of Lindahl et al, there was a non-significant trend for a beneficial effect 83 .…”

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 99%

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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: 88%

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 88%

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 99%

Section: Treatment Of Minoca Medical Treatmentmentioning

confidence: 99%

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Myocardial infarction with non-obstructive coronary artery disease

Lindahl¹,

Baron²,

Albertucci³

et al. 2021

EuroIntervention

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“…Regarding medical management of these patients, clinical registry based studies suggest MINOCA patients are often less likely to receive secondary preventive medications when compared to MICAD patients (7)(8)(9). However, studies have reported benefits of ACEI/ARB therapy (10)(11)(12)(13), statin therapy (11,14), and beta blocker (15) therapy in MINOCA. In particular, Lindahl et al (13) using data from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) registry of 9,136 MINOCA patients showed that 24% experienced a Major Adverse Coronary Events (MACE) during a mean follow-up period of 4.1 years.…”

Section: Introductionmentioning

confidence: 99%

Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment for Post Infarct Angina in Patients With Myocardial Infarction With Non-obstructive Coronary Arteries: A MINOCA-BAT Sub Study Rationale and Design

Pasupathy

Lindahl

Tavella

et al. 2021

Front. Cardiovasc. Med.

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Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in ~10% of all patients with acute myocardial infarction (AMI), with an over-representation amongst women. Remarkably, it is estimated that as many as 1 in 4 patients with MINOCA experience ongoing angina at 12 months despite having no flow-restricting stenoses in their epicardial arteries. This manuscript presents the rationale behind Randomized Evaluation of Beta Blocker and Angiotensin-converting enzyme inhibitors/Angiotensin Receptor Blocker Treatment (ACEI/ARB) for Post Infarct Angina in MINOCA patients—The MINOCA BAT post infarct angina sub study.Methods: This trial is a registry-based, randomized, parallel, open-label, multicenter trial with 2 × 2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce post infarct angina in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 664 patients will be randomized into four groups; (i) ACEI/ARB with beta blocker, (ii) beta blocker only, (iii) ACEI/ARB only, or (iv) neither ACEI/ARB nor beta blocker and followed for 12 months.Results: The trial is currently recruiting in Australia and Sweden. Fifty six patients have been recruited thus far. Both sexes were equally distributed (52% women and 48% men) and the mean age was 56.3 ± 9.9 years.Conclusions: It remains unclear whether conventional secondary preventive therapies are beneficial to MINOCA patients in regard to post infarct angina. Existing registry-based literature suggest cardioprotective agents are less likely to be used in MINOCA patients. Thus, results from this trial will provide insights for future treatment strategies and guidelines specific to MINOCA patients.

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