{"id":"c8c64bc79d1c","type":"article","url":"https://hartvaat.nl/2021/11/01/antiplaatjestherapie-bij-mi-zonder-obstructief-coronairlijden-minoca/","title":"Antiplaatjestherapie bij MI zonder obstructief coronairlijden (MINOCA)","title_en":"Antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2020-318045","source_url":"https://doi.org/10.1136/heartjnl-2020-318045","authors":["Matthias Bossard","Peggy Gao","William Boden","Gabriel Steg","Jean-Francois Tanguay","Cam Joyner","Christopher B Granger","Adnan Kastrati","David Faxon","Andrzej Budaj","Prem Pais","Giuseppe Di Pasquale","Vicent Valentin","Marcus Flather","Tiziano Moccetti","Salim Yusuf","Shamir R Mehta"],"significance":6,"published":"2021-11-01","source_date":"2021-11-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated antiplatelet therapy in patients with myocardial infarction without obstructive coronary artery disease (MINOCA), addressing the uncertain role of intensified antithrombotic treatment in this distinct MI phenotype.","created":"2026-07-03T10:29:28Z","updated":"2026-07-03T13:28:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar antiplaatjestherapie bij MI zonder obstructief coronairlijden. Behandeling van MINOCA.","abstract_original":"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. TRIAL REGISTRATION NUMBER: NCT00335452."}