Dual Antiplatelet therapy may be rather harmful to MINOCA Patients: Study

"Despite increasing data on the characteristics and prognosis of patients presenting with MINOCA, studies assessing therapies and, thus, evidence-based guidelines for the treatment of MINOCA are still limited," Matthias Bossard, MD, cardiologist at Luzerner Kantonsspital in Lucerne, Switzerland, and colleagues wrote. Researchers conducted a post-hoc analysis of Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events–Seventh Organisation to Assess Strategies in Ischaemic Symptoms (CURRENT-OASIS 7) trial. In CURRENT-OASIS 7 trial, 25,086 patients with acute coronary syndromes (ACS) referred for early intervention were randomly assigned to receive either double-dose (600mg day 1; 150mg days 2–7; then 75mg daily) or standard-dose (300mg day 1; then 75mg daily) clopidogrel. Researchers evaluated clinical outcomes at 30-days in patients with MINOCA versus without obstructive CAD and in relation to standard versus double-dose clopidogrel. The major outcome assessed was cardiovascular (CV) death, MI or stroke at 30 days.

Key findings of the study were:

• The researchers noted that patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities.

• Upon analysis, they found that all-cause mortality (0.6% vs 2.3%), CV mortality (0.6% vs 2.2%), repeat MI (0.5% vs 2.3%) and major bleeding (0.6% vs 2.4%) were lower among patients with MINOCA than among those with obstructive CAD.

• In those with MI but obstructive CAD, they noted no difference in double-dose vs standard-dose clopidogrel for the composite outcome (4.3% vs 4.7%, respectively; HR = 0.91).

• However, in those with MINOCA, they noted that those receiving double-dose clopidogrel had higher rates of the composite outcome than those receiving the standard dose (2.1% vs 0.6%; HR = 3.57)

The authors concluded, "Patients with MINOCA are at lower risk of recurrent CV events compared with patients with MI with obstructive CAD. Compared with a standard clopidogrel-based dual antiplatelet therapy (DAPT) regimen, an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. Further randomised trials evaluating the effects of potent DAPT in patients with MINOCA are warranted."

For further information:

https://heart.bmj.com/content/early/2021/01/26/heartjnl-2020-318045