Abstract
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6-8% of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial 'Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients' (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. METHODS: MINOCA-BAT is a registry-based, randomized, parallel, open-label, multicenter trial with 2:2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce the composite endpoint of death of any cause, readmission because of AMI, ischemic stroke or heart failure in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 3500 patients will be randomized into four groups; e.g. ACEI/ARB and beta blocker, beta blocker only, ACEI/ARB only and neither ACEI/ARB nor beta blocker, and followed for a mean of 4 years. SUMMARY: While patients with MINOCA have an increased risk of serious cardiovascular events and death, whether conventional secondary preventive therapies are beneficial has not been assessed in randomized trials. There is a limited basis for guideline recommendations in MINOCA. Furthermore, studies of routine clinical practice suggest that use of secondary prevention therapies in MINOCA varies considerably. Thus results from this trial may influence future treatment strategies and guidelines specific to MINOCA patients.
Highlights
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6–8%of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI)
Almost 25% of the MINOCA patients registered in the SWEDEHEART registry suffered a major adverse cardiac event (MACE) within 4 years, defined as death, recurrent MI, heart failure hospitalization or stroke.[1]
In a recent propensity score-matched analysis of 9138 patients with MINOCA enrolled in the SWEDEHEART registry we evaluated the relationship between treatment with statins, ACE-inhibitor/angiotensin receptor blocker (ACEI/ARB) treatment, beta-blockers, dual antiplatelet therapy and the composite of all-cause mortality or hospitalization for reinfarction, heart failure, or stroke
Summary
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6–8%. Of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial ‘Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients’ (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and affect 6% to 8% of all Nordenskjöld et al 97 and structured investigations recommended.[7] The notion of MINOCA as a working diagnosis is highlighted in several recent international guidelines and statements.[8,9,10]. Besides the atherosclerotic status of the coronary arteries there are several fundamental differences between patients with MINOCA and patients with AMI and obstructive coronary artery disease (MI-CAD). This high rate of long-term serious cardiovascular events is particular worrisome when considering the younger age and more favorable clinical profile of MINOCA patients compared to patients with MI-CAD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
