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- Dokumenttyp:
- Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
- Autor(en):
- Bossard, Matthias; Gao, Peggy; Boden, William; Steg, Gabriel; Tanguay, Jean-Francois; Joyner, Cam; Granger, Christopher B; Kastrati, Adnan; Faxon, David; Budaj, Andrzej; Pais, Prem; Di Pasquale, Giuseppe; Valentin, Vicent; Flather, Marcus; Moccetti, Tiziano; Yusuf, Salim; Mehta, Shamir R
- Titel:
- Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease.
- Abstract:
- OBJECTIVE: Approximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated. METHODS: We analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2-7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days. RESULTS: We included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p<0.0001) were lower among patients with MINOCA than among those with obstructive CAD. Among patients with MINOCA, 2.1% of patients in the double-dose clopidogrel group and 0.6% in the standard-dose group experienced a primary outcome (HR 3.57, 95% CI 1.31 to 9.76), whereas in those with obstructive CAD, rates were 4.3% and 4.7%, respectively (HR 0.91, 95% CI 0.80 to 1.03; p value for interaction=0.011). CONCLUSIONS: 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. TRIAL REGISTRATION NUMBER: NCT00335452.
- Zeitschriftentitel:
- Heart
- Jahr:
- 2021
- Band / Volume:
- 107
- Heft / Issue:
- 21
- Seitenangaben Beitrag:
- 1739-1747
- Volltext / DOI:
- doi:10.1136/heartjnl-2020-318045
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/33504513
- Print-ISSN:
- 1355-6037
- TUM Einrichtung:
- Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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