De Filippo Ovidio, Russo Caterina, Manai Rossella, Borzillo Irene, Savoca Federica, Gallone Guglielmo, Bruno Francesco, Ahmad Mahmood, De Ferrari Gaetano Maria, D'Ascenzo Fabrizio
Cardiovascular and thoracic department, A.O.U. Città della Salute e della Scienza, Turin, Italy and Department of Medical Sciences, University of Turin, Italy.
Cardiovascular and thoracic department, A.O.U. Città della Salute e della Scienza, Turin, Italy and Department of Medical Sciences, University of Turin, Italy.
Int J Cardiol. 2022 Dec 1;368:1-9. doi: 10.1016/j.ijcard.2022.08.034. Epub 2022 Aug 18.
To assess the impact of secondary prevention medical therapies (statins, ACE-inhibitors/Angiotensin Receptor Blockers (ARB), beta-blockers (BB) and Dual Antiplatelet Therapy (DAPT)) on outcomes of patients with myocardial infarction with nonobstructive coronary artery disease (MINOCA).
Five adjusted observational studies encompassing 10,546 were included in this meta-analysis. All-cause death was the primary endpoint, while Major Adverse Cardiovascular Events (MACE) and acute myocardial infarction (AMI) were the secondary endpoints.
After 24 months of follow up, statins (tested in 8093 patients) were associated with a reduced risk of all-cause death (HR 0.60:0.45-0.81, p 〈0,001), while ACE-inhibitors/ARB (on 9666 patients) were not. Aggregate data from two studies (n = 9720, 7719 on beta-blockers, 6423 on DAPT) indicated that beta-blockers and DAPT (median follow-up 34.1 and 15.7 months, respectively) were both associated with a significant reduction of all-cause death (HR0.81:0.66-0.99, p = 0.04, and HR0.73:0.55-0.98, p = 0.03, for beta-blockers and DAPT, respectively). Among the investigated therapies, only ACE-inhibitors/ARBs entailed a reduced risk of MACE (HR0.65:0.44-0.94, p = 0.02, all CI 95%) over 36.5 months (four studies, n = 10,150). None of the investigated therapies was associated with a reduced risk of AMI.
Data from adjusted observational studies suggest that beta-blockers, statins and DAPT are associated with a survival benefit among MINOCA patients. ACE-inhibitors/ARB entail a reduced risk of MACE while none of the investigated secondary prevention therapies is associated with a reduced risk of AMI. Randomized controlled trials are warranted to confirm these findings.
评估二级预防药物治疗（他汀类药物、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ARB）、β受体阻滞剂（BB）和双联抗血小板治疗（DAPT））对非阻塞性冠状动脉疾病心肌梗死（MINOCA）患者预后的影响。
本荟萃分析纳入了五项调整后的观察性研究，共10546例患者。全因死亡是主要终点，而主要不良心血管事件（MACE）和急性心肌梗死（AMI）是次要终点。
随访24个月后，他汀类药物（在8093例患者中进行测试）与全因死亡风险降低相关（HR 0.60:0.45 - 0.81，p〈0.001），而血管紧张素转换酶抑制剂/ARB（在9666例患者中使用）则不然。两项研究（n = 9720，其中7719例使用β受体阻滞剂，6423例使用DAPT）的汇总数据表明，β受体阻滞剂和DAPT（中位随访时间分别为34.1个月和15.7个月）均与全因死亡显著降低相关（β受体阻滞剂和DAPT的HR分别为0.81:0.66 - 0.99，p = 0.04，以及HR 0.73:0.55 - 0.98，p = 0.03）。在研究的治疗方法中，只有血管紧张素转换酶抑制剂/ARB在36.5个月内（四项研究，n = 10150）使MACE风险降低（HR 0.65:0.44 - 0.94，p = 0.02，所有CI为95%）。没有一种研究的治疗方法与AMI风险降低相关。
调整后的观察性研究数据表明，β受体阻滞剂、他汀类药物和DAPT对MINOCA患者有生存益处。血管紧张素转换酶抑制剂/ARB可降低MACE风险，而没有一种研究的二级预防治疗方法与AMI风险降低相关。需要进行随机对照试验来证实这些发现。
