Key result
Dual antiplatelet therapy was associated with a non-significant trend toward lower risk of major adverse cardiovascular events in patients with MINOCA (HR 0.82; 95% CI 0.66-1.03).
Why the study?
Dual antiplatelet therapy is established for secondary prevention in traditional myocardial infarction, but its role in MINOCA remains unclear.
Does dual antiplatelet therapy (DAPT) reduce major adverse cardiovascular events (MACE) in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA)?
Meta-Analysis (n=12,307)
Does dual antiplatelet therapy (DAPT) reduce major adverse cardiovascular events (MACE) in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA)?
In a meta-analysis of cohort studies, DAPT showed a non-significant trend toward reducing MACE in patients with MINOCA, highlighting the need for randomized trials to clarify its role.
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.
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Efthymiou et al. (2025) conducted a meta-analysis in Myocardial infarction with nonobstructive coronary arteries (MINOCA) (n=12,307). Dual antiplatelet therapy (DAPT) was evaluated on Major adverse cardiovascular events (MACE) (HR 0.82, 95% CI 0.66-1.03, p=Not significant). Dual antiplatelet therapy was associated with a non-significant trend toward lower risk of major adverse cardiovascular events in patients with MINOCA (HR 0.82; 95% CI 0.66-1.03).
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