February 8, 2017Circulation
Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease
Key result
In patients with MINOCA, statins (HR 0.77; 95% CI 0.68-0.87) and ACEI/ARBs (HR 0.82; 95% CI 0.73-0.93) were associated with a lower risk of major adverse cardiac events.
Why the study?
Does secondary prevention medical therapy (statins, ACEi/ARB, beta-blockers, or DAPT) reduce major adverse cardiac events in patients with MINOCA?
Population
9,136 patients with myocardial infarction with nonobstructive coronary arteries surviving the first 30 days…
Comparison
Treatment at discharge with statins… vs Untreated groups matched by stratified…
Design
Cohort
Follow-up
mean 4.1 years
Authors
Discussion
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Member takes
Implication
May support statin and ACEI/ARB use in MINOCA; leaves open need for RCTs to confirm benefit.
Study Design
Type
Observational (n=9,136)
Multicenter
Yes
Structured PICO
Does secondary prevention medical therapy (statins, ACEi/ARB, beta-blockers, or DAPT) reduce major adverse cardiac events in patients with MINOCA?
P
Population
9,136 patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) surviving 30 days post-discharge, followed for a mean of 4.1 years.
E
Exposure
Treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB), beta-blockers, or dual antiplatelet therapy (DAPT).
C
Comparator
Untreated groups matched by stratified propensity score analysis.
O
Outcome
Major adverse cardiac events defined as all-cause mortality, hospitalization for myocardial infarction, ischemic stroke, and heart failure.composite
Main Result
Hazard Ratio: 0.77 (95% CI 0.68–0.87)
In patients with MINOCA, secondary prevention with statins and ACEi/ARB is associated with a significant reduction in long-term major adverse cardiac events.
Cite This Study
Lindahl et al. (2017) conducted an observational in Myocardial infarction with nonobstructive coronary arteries (MINOCA) (n=9,136). Statins, ACEI/ARBs, beta-blockers, and dual antiplatelet therapy vs. Untreated patients was evaluated on Major adverse cardiac events defined as all-cause mortality, hospitalization for myocardial infarction, ischemic stroke, and heart failure (HR 0.77, 95% CI 0.68-0.87). In patients with MINOCA, statins (HR 0.77; 95% CI 0.68-0.87) and ACEI/ARBs (HR 0.82; 95% CI 0.73-0.93) were associated with a lower risk of major adverse cardiac events.