What are the long-term outcomes of treatments for MINOCA disease?

This study aimed to investigate the long-term effects of different treatments for patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease.

This study concluded that statins and ACE inhibitors/angiotensin receptor blockers provided long-term benefit to patients with MINOCA disease. 

MINOCA disease is a form of myocardial infarction (MI), also known as heart attack. MINOCA is found in around 10% of patients who have had an MI. In MINOCA disease, there is not as much build-up of plaque and blocking of the arteries that deliver blood to the heart. Very little is known about MINOCA and how to treat it.

Statins, ACE inhibitors/angiotensin receptor blockers (ACEI/ARB), beta blockers and dual antiplatelet therapy (DAPT) are treatments given following an MI or those at risk of MI. These treatments lower blood pressure or cholesterol levels (fatty build-up in the blood vessels). It was unknown if these treatments would be suitable for MINOCA disease patients. The long-term effects of these treatments were also unknown. 

This study examined the records of 9136 MINOCA patients. Treatments received following the MI and heart-related events were recorded. These included all-cause mortality, hospitalization for heart attack, ischemic stroke and heart failure. Patients were followed for an average of 4.1 years.

84.5% of patients were treated with statins. 83.4% of patients were treated with beta blockers. 64.1% received an ACEI/ARB. 66.4% received DAPT.

23.9% of patients experience a heart related event. Patients treated with statins had a 23% decreased risk of a heart-related event. Patients treated with ACEI/ARB had an 18% decreased risk. Those treated with beta blockers had a 14% decreased risk compared to untreated patients.

Patients who received DAPT reported side effects after 1 year and had a 10% decreased risk of experiencing heart related side effects compared to untreated patients. 

This study concluded that there are positive long-term outcomes for MINOCA patients treated with statins and ACEI/ARB. It was also concluded that beta blockers may have a positive effect. 

Further research needs to be done to confirm these findings.