Dual antiplatelet therapy reduces all-cause death but not MACE or myocardial infarction in MINOCADual antiplatelet therapy shows survival benefits for MINOCA patients

This meta-analysis evaluated the clinical outcomes of dual antiplatelet therapy (DAPT) in a population of 13027 patients diagnosed with myocardial infarction with nonobstructive coronary artery disease (MINOCA). The study aimed to determine the efficacy of DAPT over a follow-up period of 48.0 months, focusing on both primary and secondary cardiovascular outcomes.

The intervention analyzed was dual antiplatelet therapy (DAPT), while specific comparator details were not reported in the data. The analysis focused on patients specifically presenting with MINOCA, a condition characterized by myocardial infarction despite the absence of obstructive coronary artery disease. This population is often clinically challenging due to the underlying etiology of the infarct.

The primary outcome measured was major adverse cardiovascular events (MACE). The results indicated no significant association with a reduced risk for MACE, reporting an effect size of 1.00 (95% CI, 0.71-1.41; P =.985). This suggests that DAPT did not significantly alter the frequency of major cardiovascular events in this specific cohort over the 48.0 month period.

Secondary outcomes included all-cause death and myocardial infarction. For all-cause death, a significant reduction was observed with an effect size of 0.76 (95% CI, 0.60-0.96; P =.021). In contrast, the results for myocardial infarction were not statistically significant, showing an effect size of 1.03 (95% CI, 0.72-1.45; P =.885). These findings highlight a specific survival benefit associated with DAPT that does not translate to a reduction in MACE or recurrent myocardial infarction.

Safety and tolerability data were not reported for this analysis. Consequently, the rate of adverse events, serious adverse events, or treatment discontinuations is unknown. This lack of safety data limits the ability to assess the risk-benefit profile of DAPT specifically regarding side effects in the MINOCA population.

When compared to broader myocardial infarction management, these results provide specific insights into the MINOCA subgroup. While many interventions for myocardial infarction aim to reduce MACE as a composite endpoint, this meta-analysis identifies that DAPT specifically impacts all-cause mortality in MINOCA patients without significantly impacting the components of MACE or the incidence of subsequent myocardial infarctions. The study noted heterogeneity among studies as a primary methodological limitation. This heterogeneity can impact the precision of the pooled estimates and may reflect differences in patient demographics, DAPT regimens, or follow-up protocols across the included studies. The lack of reported safety data also remains a significant gap for clinical interpretation.

Clinically, these results suggest that DAPT provides a measurable survival benefit for patients with MINOCA. However, clinicians should note that this benefit is not reflected in the reduction of MACE or myocardial infarction rates. Practice decisions may need to balance the known mortality benefits against the lack of evidence for reduced MACE or recurrence. Questions remain regarding the specific mechanisms driving the reduction in all-cause death and how these results compare to other antiplatelet strategies in nonobstructive coronary disease.