Secondary Prevention in Patients With MINOCA

Study Questions:

Are secondary prevention medications effective among patients after myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA)?

Methods:

This was an observational study of MINOCA patients identified through the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapy) registry between July 2003 and June 2013. Participants were followed until December 2013 for outcome events through the Swedish Cause of Death Register and National Patient Register. From admissions for MI, patients with MINOCA who survived 30 or more days after discharge were included in this study. A stratified propensity score analysis was performed to match treated and untreated groups. The exposures of interest were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARBs), beta-blockers, and dual antiplatelet therapy (DAPT). The primary endpoint was major adverse cardiac events (MACE) defined as all-cause mortality, hospitalization for MI, ischemic stroke, and heart failure.

Results:

From a total of 199,162 admissions for MI, 9,466 consecutive patients with MINOCA were included in the present analysis. Mean age was 65 years and 61% were women. At discharge, 84.5% of the patients were on statins, 64.1% were on ACEI/ARBs, 83.4% were on beta-blockers, and 66.4% were on DAPT. During the follow-up of a mean of 4.1 years, 2,183 (23.9%) patients experienced a MACE. The hazard ratios (HRs) for MACE were 0.77 (95% confidence interval, 0.68-0.87) for patients on statins, 0.82 (0.73-0.93) for patients on ACEI/ARBs, and 0.86 (0.74-1.01) for patients on beta-blockers. For patients on DAPT, no significant association was observed for MACE.

Conclusions:

The authors concluded that these results indicate long-term beneficial effects on outcome in patients with MINOCA of treatment with statins and ACEI/ARBs, a trend toward a positive effect of beta-blocker treatment, and a neutral effect of DAPT.

Perspective:

These data support the use of statins, and ACEI/ARBs for patients who have been diagnosed with MI and MINOCA. As the authors suggest, these data indicate that a randomized clinical trial is warranted.

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Nonstatins, Novel Agents, Statins, Acute Heart Failure

Keywords: Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Coronary Artery Disease, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Myocardial Infarction, Platelet Aggregation Inhibitors, Secondary Prevention, Stroke


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