Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: A Systematic Review and Meta-Analysis

Myocardial infarction with nonobstructive coronary arteries (MINOCA) represents a clinical challenge due to its diverse etiologies and uncertain prognosis. Dual antiplatelet therapy (DAPT) is a cornerstone of secondary prevention in traditional myocardial infarction, but its role in MINOCA remains unclear. The purpose of this review was to systematically search the literature and perform a meta-analysis on the effect of DAPT for secondary prevention in patients with MINOCA. A systematic search was conducted in PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2024. Cohort studies involving MINOCA patients treated with DAPT and reporting major adverse cardiovascular events (MACE) during follow-up were included. Meta-analysis was conducted using DerSimonian and Laird random-effects model. Seven studies with 12,307 MINOCA patients were included. Meta-analysis showed a trend toward a lower risk of MACE in patients receiving DAPT (pooled hazard ratio: 0.82, 95% confidence interval: 0.66-1.03); however, the results were not statistically significant. DAPT may reduce the risk of MACE in MINOCA patients, but the evidence is not conclusive. Further trials are needed to confirm these findings.

MINOCA: One Size Fits All? Probably Not—A Review of Etiology, Investigation, and Treatment

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous group of conditions that include both atherosclerotic (coronary plaque disruption) and non-atherosclerotic (spontaneous coronary artery dissection, coronary artery spasm, coronary artery embolism, coronary microvascular dysfunction, and supply–demand mismatch) causes resulting in myocardial damage that is not due to obstructive coronary artery disease. Failure to identify the underlying cause may result in inadequate and inappropriate therapy in these patients. The cornerstone of managing MINOCA patients is to identify the underlying mechanism to achieve the target treatment. Intravascular imaging is able to identify different morphologic features of coronary plaques, while cardiac magnetic resonance is the gold standard for detection of myocardial infarction in the setting of MINOCA. In this review, we summarize the relevant clinical issues, contemporary diagnosis, and treatment options of MINOCA.