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August 5, 2026Cardiovascular MedicineOpen Access

Mechanism-Informed Drug Repurposing in MINOCA: Therapeutic Rationale and Trial Framework for Empagliflozin and Colchicine

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Key result

Empagliflozin and colchicine emerge as potential mechanism-informed therapies for MINOCA pending prospective trial validation.

Why the study?

MINOCA pharmacologic management is largely extrapolated from obstructive coronary artery disease, causing a mismatch with underlying mechanisms, while direct evidence for empagliflozin and colchicine remains limited and predominantly observational.

Does phenotype-guided therapy with empagliflozin or colchicine improve outcomes in patients with MINOCA?

Population

Patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA)

Design

Review

Authors

ZDZainab Atiyah Dakhil

Discussion

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Overview

Improved MINOCA adjudication may refine therapy selection; leaves open mechanism-specific trials.

Key Points

  • This work aims to develop a therapeutic framework for MINOCA based on mechanistic understanding and drug repurposing.
  • Integration of mechanistic and clinical evidence into a comparative therapeutic framework.
  • Proposed trial strategy includes diagnostic adjudication and phenotype enrichment.
  • Utilizes biomarker-guided stratification and adaptive or factorial designs.
  • Proposed framework generates hypotheses for future trials and is designed for prospectively informed investigation.
  • Empagliflozin and colchicine show cardiovascular benefits across select biological domains.

Structured PICO

Does phenotype-guided therapy with empagliflozin or colchicine improve outcomes in patients with MINOCA?

P
Population
Patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA)
I
Intervention
Empagliflozin and colchicine (proposed trial framework)

This review proposes a phenotype-linked therapeutic framework and trial design to investigate empagliflozin and colchicine for the management of MINOCA.

Limitations

  • Direct evidence for empagliflozin and colchicine in MINOCA remains limited and predominantly observational.
  • The proposed framework is hypothesis-generating and intended to inform prospective investigation rather than support off-label prescribing.
  • Direct evidence in MINOCA remains limited and predominantly observational
  • Proposed framework is hypothesis-generating and intended to inform prospective investigation rather than support off-label prescribing

Cite This Study

Zainab Atiyah Dakhil (2026) conducted a review in Myocardial infarction with non-obstructive coronary arteries (MINOCA). Empagliflozin and colchicine was evaluated. A proposed trial framework integrates mechanistic and clinical evidence to investigate empagliflozin and colchicine for phenotype-guided treatment in patients with MINOCA.

synapsesocial.com/papers/6a72e7d2226790f37065720dhttps://doi.org/10.3390/cardiovascmed29030029
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnostic work-up and Therapeutic Implications in MINOCA: Need for a Personalized Approach2020 · 34 citations
  2. 2Diagnostic Advancements in MINOCA: Do They Translate to a Better Clinical Outcome? A Review of the Literature2026 · 1 citations
  3. 3Myocardial Infarction With Non-Obstructive Coronary Artery Disease: Exploration of the Etiology to Guide Therapy2026
  4. 4Myocardial infarction with nonobstructive coronary arteries: the need for precision medicine2022 · 6 citations
  5. 5The PROMISE of Precision Medicine in Myocardial Infarction with Non-Obstructive Coronary Arteries2025 · 2 citations