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. 2025 Apr 4.
doi: 10.1097/CRD.0000000000000890. Online ahead of print.

Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: A Systematic Review and Meta-Analysis

Ioannis Efthymiou  1 , Sotirios Chiotis  2 , Christina Vlachvei  3 , Sotirios Mitsiadis  2 , Grigorios Giamouzis  4 , Miltiadis I Matsagkas  5 , Vasileios Vasilikos  2
Affiliations

Dual Antiplatelet Therapy and Clinical Outcomes in Patients With Myocardial Infarction With Nonobstructive Coronary Arteries: A Systematic Review and Meta-Analysis

Ioannis Efthymiou et al. Cardiol Rev. .

Abstract

Myocardial infarction with nonobstructive coronary arteries (MINOCA) represents a clinical challenge due to its diverse etiologies and uncertain prognosis. Dual antiplatelet therapy (DAPT) is a cornerstone of secondary prevention in traditional myocardial infarction, but its role in MINOCA remains unclear. The purpose of this review was to systematically search the literature and perform a meta-analysis on the effect of DAPT for secondary prevention in patients with MINOCA. A systematic search was conducted in PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) up to June 2024. Cohort studies involving MINOCA patients treated with DAPT and reporting major adverse cardiovascular events (MACE) during follow-up were included. Meta-analysis was conducted using DerSimonian and Laird random-effects model. Seven studies with 12,307 MINOCA patients were included. Meta-analysis showed a trend toward a lower risk of MACE in patients receiving DAPT (pooled hazard ratio: 0.82, 95% confidence interval: 0.66-1.03); however, the results were not statistically significant. DAPT may reduce the risk of MACE in MINOCA patients, but the evidence is not conclusive. Further trials are needed to confirm these findings.

Keywords: MINOCA; dual antiplatelet therapy; meta-analysis; myocardial infarction; nonobstructive coronary arteries; secondary prevention.

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Conflict of interest statement

Disclosures: The authors have no conflicts of interest to report.

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