Key result
This rationale and design paper describes an ongoing randomized controlled trial evaluating the impact of beta-blockers and ACEI/ARBs on post-infarct angina in patients with MINOCA; no efficacy results are available yet.
Why the study?
Up to 1 in 4 MINOCA patients experience ongoing angina at 12 months, but whether conventional secondary preventive therapies reduce post infarct angina in MINOCA remains unclear.
Does oral beta blocker and/or ACEI/ARB reduce post infarct angina in patients with MINOCA and LVEF ≥40%?
RCT (n=664)
Open-label
Permuted block randomization with 1:1:1:1 ratio
Yes
Does oral beta blocker and/or ACEI/ARB reduce post infarct angina in patients with MINOCA and LVEF ≥40%?
Answers are grounded in this paper and cite their sources.
This trial will provide the first randomized evidence on whether beta-blockers and ACEI/ARBs improve post-infarct angina and quality of life in patients with MINOCA.
Introduction: Myocardial infarction with non-obstructive coronary arteries (MINOCA) occurs in ~10% of all patients with acute myocardial infarction (AMI), with an over-representation amongst women. Remarkably, it is estimated that as many as 1 in 4 patients with MINOCA experience ongoing angina at 12 months despite having no flow-restricting stenoses in their epicardial arteries. This manuscript presents the rationale behind Randomized Evaluation of Beta Blocker and Angiotensin-converting enzyme inhibitors/Angiotensin Receptor Blocker Treatment (ACEI/ARB) for Post Infarct Angina in MINOCA patients—The MINOCA BAT post infarct angina sub study. Methods: This trial is a registry-based, randomized, parallel, open-label, multicenter trial with 2 × 2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce post infarct angina in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 664 patients will be randomized into four groups; (i) ACEI/ARB with beta blocker, (ii) beta blocker only, (iii) ACEI/ARB only, or (iv) neither ACEI/ARB nor beta blocker and followed for 12 months. Results: The trial is currently recruiting in Australia and Sweden. Fifty six patients have been recruited thus far. Both sexes were equally distributed (52% women and 48% men) and the mean age was 56.3 ± 9.9 years. Conclusions: It remains unclear whether conventional secondary preventive therapies are beneficial to MINOCA patients in regard to post infarct angina. Existing registry-based literature suggest cardioprotective agents are less likely to be used in MINOCA patients. Thus, results from this trial will provide insights for future treatment strategies and guidelines specific to MINOCA patients.
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Pasupathy et al. (2021) conducted an RCT in Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) (n=664). Beta blocker and/or ACEI/ARB vs. No beta blocker and/or no ACEI/ARB was evaluated on Angina frequency measured by SAQ-7 at 12 months. This rationale and design paper describes an ongoing randomized controlled trial evaluating the impact of beta-blockers and ACEI/ARBs on post-infarct angina in patients with MINOCA; no efficacy results are available yet.
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