干旱区生态环境知识资源中心(Arid): Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease

Arid

DOI	10.1136/heartjnl-2020-318045
	Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease
	Bossard, Matthias; Gao, Peggy; Boden, William; Steg, Gabriel; Tanguay, Jean-Francois; Joyner, Cam; Granger, Christopher B.; Kastrati, Adnan; Faxon, David; Budaj, Andrzej; Pais, Prem; Di Pasquale, Giuseppe; Valentin, Vicent; Flather, Marcus; Moccetti, Tiziano; Yusuf, Salim; Mehta, Shamir R.
通讯作者	Mehta, SR (corresponding author), Hamilton Gen Hosp, Div Cardiol, Hamilton, ON L8L 2X2, Canada.
来源期刊	HEART
ISSN	1355-6037
EISSN	1468-201X
出版年	2021
卷号	107 期号:21 页码:1739-1747
英文摘要	Objective Approximately 10% of patients with myocardial infarction (MI) have no obstructive coronary artery disease. The prognosis and role of intensified antiplatelet therapy in those patients were evaluated. Methods We analysed data from the Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events-Seventh Organisation to Assess Strategies in Ischaemic Symptoms trial randomising patients with ACS referred for early intervention to receive either double-dose (600 mg, day 1; 150 mg, days 2-7; then 75 mg/day) or standard-dose (300 mg, day 1; then 75 mg/day) clopidogrel. Outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) versus those with obstructive coronary artery disease (CAD) and their relation to standard-dose versus double-dose clopidogrel were evaluated. The primary outcome was cardiovascular (CV) death, MI or stroke at 30 days. Results We included 23 783 patients with MI and 1599 (6.7%) with MINOCA. Patients with MINOCA were younger, presented more frequently with non-ST-segment elevation MI and had fewer comorbidities. All-cause mortality (0.6% vs 2.3%, p=0.005), CV mortality (0.6% vs 2.2%, p=0.006), repeat MI (0.5% vs 2.3%, p=0.001) and major bleeding (0.6% vs 2.4%, p<0.0001) were lower among patients with MINOCA than among those with obstructive CAD. Among patients with MINOCA, 2.1% of patients in the double-dose clopidogrel group and 0.6% in the standard-dose group experienced a primary outcome (HR 3.57, 95% CI 1.31 to 9.76), whereas in those with obstructive CAD, rates were 4.3% and 4.7%, respectively (HR 0.91, 95% CI 0.80 to 1.03; p value for interaction=0.011). Conclusions Patients with MINOCA are at lower risk of recurrent CV events compared with patients with MI with obstructive CAD. Compared with a standard clopidogrel-based dual antiplatelet therapy (DAPT) regimen, an intensified dosing strategy appears to offer no additional benefit with a signal of possible harm. Further randomised trials evaluating the effects of potent DAPT in patients with MINOCA are warranted.
英文关键词	acute coronary syndromes acute myocardial infarction coronary artery disease
类型	Article
语种	英语
收录类别	SCI-E
WOS记录号	WOS:000708990900013
WOS关键词	CURRENT-OASIS 7 ; ST ; ASPIRIN ; INTERVENTION ; CLOPIDOGREL ; OUTCOMES
WOS类目	Cardiac & Cardiovascular Systems
WOS研究方向	Cardiovascular System & Cardiology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/363504
作者单位	Luzerner Kantonsspital, Heart Ctr, Cardiol Div, Luzern, Switzerland; [Gao, Peggy; Yusuf, Salim; Mehta, Shamir R.] Populat Hlth Res Inst PHRI, Hamilton, ON, Canada; [Boden, William] VA Boston Hlth Care Syst, Med, West Roxbury Campus, West Roxbury, MA USA; [Boden, William] Boston Univ, Sch Med, Boston, MA 02118 USA; [Steg, Gabriel] Hop Bichat Claude Bernard, Dept Cardiol, Paris, France; [Tanguay, Jean-Francois] Montreal Heart Inst, Montreal, PQ, Canada; [Joyner, Cam] Univ Toronto, Sunnybrook Hlth Sci, Toronto, ON, Canada; [Granger, Christopher B.] Duke Univ, Med Ctr, Dept Med, Div Cardiol, Durham, NC 27710 USA; [Kastrati, Adnan] Deutsch Herzzentrum Munich, Munich, Germany; [Faxon, David] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA; [Budaj, Andrzej] Grochowski Hosp, Dept Cardiol, Warsaw, Poland; [Pais, Prem] St Johns Med Coll & Res Inst, Div Clin Res & Training, Bangalore, Karnataka, India; [Di Pasquale, Giuseppe] Maggiore Hosp Carlo Alberto Pizzardi, Dept Cardiol, Emilia R...
推荐引用方式 GB/T 7714	Bossard, Matthias,Gao, Peggy,Boden, William,et al. Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease[J],2021,107(21):1739-1747.
APA	Bossard, Matthias.,Gao, Peggy.,Boden, William.,Steg, Gabriel.,Tanguay, Jean-Francois.,...&Mehta, Shamir R..(2021).Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease.HEART,107(21),1739-1747.
MLA	Bossard, Matthias,et al."Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease".HEART 107.21(2021):1739-1747.