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Dual anti-platelet therapy in myocardial infarction with non-obstructive coronary artery disease

Session Myocardial infarction and non-obstructive coronary artery disease: MINOCA in men and women

Speaker Fernando Montenegro Sa

Event : ESC Congress 2018

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Acute Coronary Syndromes: Myocardial Infarction with Non-obstructive Coronary Arteries
  • Session type : Advances in Science

Authors : F Montenegro Sa (Leiria,PT), R Carvalho (Leiria,PT), L Santos (Leiria,PT), C Ruivo (Leiria,PT), A Antunes (Leiria,PT), J Morais (Leiria,PT)

Authors:
F. Montenegro Sa1 , R. Carvalho1 , L. Santos1 , C. Ruivo1 , A. Antunes1 , J. Morais1 , 1Hospital Santo Andre, Cardiology - Leiria - Portugal ,

On behalf: the Portuguese Registry of Acute Coronary Syndromes

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 677

Introduction: Dual antiplatelet therapy (DAPT) is currently one of the mainstays of medical management in patients with acute coronary syndromes. In patients with myocardial infarction (MI) and non-obstructive coronary artery disease (MINOCA), the role of DAPT is not established and clear recommendations are lacking.

Aim: This study aims to identify for which MINOCA patients is DAPT currently used, in a large nationwide database.

Methods: The authors analysed the database from a multicentre national prospective registry enrolling patients with a first MI between 2010 and 2017, who underwent a coronary angiography revealing absence of any lesion responsible for ≥50% of luminal reduction. In order to search for DAPT predictors, a multivariate analysis with logistic regression was applied and included demographic, clinical and laboratorial data, past medical history, findings of coronary angiography and MI type.

Results: From a total of 16 237 patients analysed, 709 (4.4%) were included as MINOCA. Mean age was 64±13 years, 46.3% (n=409) were females and ST-segment elevation MI (STEMI) was identified in 20.2% (n=145). Included patients had a previous percutaneous coronary intervention (PCI) in 10.2% (n=72). The presence of trivial coronary lesions (<50% of luminal reduction) was identified in 36.1% (n=256). At discharge, DAPT was used in 390 (55.0%) patients. The multivariate analysis results are presented in the table.

Conclusion: Despite the lack of clear recommendations for the use of antithrombotics in patients with MINOCA, in a large nationwide registry DAPT was prescribed at discharge in 55% of patients. The explanation for this surprising high rate of DAPT in patients with non-obstructive coronary artery disease is not clear. Beyond sinus rhythm, the variables here presented as independent predictors for DAPT use identify groups of patients which are usually thought of as more prone to pro-thrombotic events. How to handle antithrombotics in MINOCA patients is an open topic for discussion requiring additional appropriate investigation.

DAPT use predictors
OR95CIp-value
Male gender1.671.05–2.380.027
Active smoker1.821.05–3.160.033
Previous PCI3.181.48–6.810.003
Diagnosis: ST-segment elevation myocardial infarction2.701.59–4.76<.001
Sinus Rhythm at admission3.942.07–7.48<0.001
DAPT: Dual antiplatelet therapy; PCI: percutaneous coronary intervention;.

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