Dual Antiplatelet therapy may be rather harmful to MINOCA Patients: Study
Approximately 10% of patients presenting with myocardial infarction (MI) do not have obstructive coronary artery disease (MINOCA). A recent study suggests that patients with MINOCA have fewer recurrent events than those with MI and obstructive CAD but an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. The research has been published in the journal Heart on January 27, 2021.
"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
