Myocardial ischemia in nonobstructive coronary arteries: A review of diagnostic dilemmas, current perspectives, and emerging therapeutic innovations

Table 10 Observational studies on the efficacy of cardioprotective therapies in myocardial infarction with nonobstructive coronary arteries

Ref.	Methodology	Results
		DAPT	Statins	Beta-blockers	ACEI/ARB	CCB
Lindahl et al[65], 2017	Observational study on the data from the SWEDEHEART registry collected between July 2003 and June 2013 and followed up to December 2013, involving 9466 cases of MINOCA. Incidence of MACE was measured after a mean follow-up of 4.1 years	Nonsignificant 10% reduction in MACE post-discharge (HR = 0.90; 95%CI: 0.74-1.08)	Significant 23% reduction in MACE (HR = 0.77; 95%CI: 0.68-0.87)	Nonsignificant 14% reduction in MACE (HR = 0.86; 95%CI: 0.74-1.01)	Significant 18% reduction in MACE rate (HR = 0.82; 95%CI: 0.73-0.93)	N/A
Paolisso et al[68], 2019	Study based on the database of Bologna University Hospital between January 2016 and December 2018 involving patients of acute myocardial infarction (including 134 MINOCA cases) undergoing coronary angiography within the first 48 hours of hospitalization. The average follow-up period was 19.35 ± 10.6 months	A nonsignificant reduction in MACE (HR = 0.42; 95%CI: 0.14-1.24)	A nonsignificant reduction in MACE (HR = 0.44; 95%CI: 0.16-1.22)	A nonsignificant reduction in MACE (HR = 0.43; 95%CI: 0.14-1.35)	Significant reduction in MACE (HR = 0.29; 95%CI: 0.10-0.81)	N/A
Abdu et al[67], 2020	Single center retrospective study on 259 MINOCA patients between 2014 to 2018 after a follow-up duration of 2 years	Nonsignificant effect on MACE (HR = 1.53; 95%CI: 0.78-3.01)	Significant decrease in MACE (HR = 0.467; 95%CI: 0.239-0.911)	Nonsignificant effect on MACE (HR = 1.043; 95%CI: 0.547-1.988)	Significant decrease in MACE (HR = 0.486; 95%CI: 0.237-0.996)	N/A
Kovach et al[66], 2021	A propensity-matching study on the data collected from the Veterans Affairs Clinical Assessment, Reporting and Tracking program on troponin-positive patients who had undergone coronary angiography between October 2008 and September 2017. The positive cohort consisted of 1986 cases of MINOCA. The mean follow-up period is 1 year	Nonsignificant effect on MACE with P2Y12 inhibitor (HR = 1.02; 95%CI: 0.58-1.80)	Significant decrease in MACE (HR = 0.34; 95%CI: 0.23-0.51)	Nonsignificant effect on MACE (HR = 1.09; 95%CI: 0.73-1.62)	Significant decrease in MACE with ACEI use (HR = 0.51; 95%CI: 0.33-0.79)	A nonsignificant reduction in MACE (HR = 0.63; 95%CI: 0.38-1.04)
Ciliberti et al[71], 2021	A retrospective multicentric cohort study on 621 patients with MINOCA from 9 Hub Hospitals across Italy between March 2012 and March 2018. The mean follow-up duration is 90 months	Nonsignificant effect on MACE (HR = 2.25; 95%CI: 0.58-8.79)	Nonsignificant effect on MACE (HR = 1.67; 95%CI: 0.91-3.05)	Significant reduction in MACE observed (HR = 0.49; 95%CI: 0.31-0.79)	Nonsignificant effect on MACE (HR = 0.70; 95%CI: 0.40-2.21)	Nonsignificant effect on MACE (HR = 1.41; 95%CI: 0.77-2.50)
Bossard et al[64], 2021	Post hoc analysis of the OASIS 7 trial comparing MACE outcomes among 1599 MINOCA patients with double-strength and standard clopidogrel-based DAPT regimen after a follow-up of 1 year	No additional benefit of double-strength clopidogrel over the standard dose (HR = 3.57; 95%CI: 1.31-9.76)	N/A	N/A	N/A	N/A

DAPT: Dual antiplatelet therapy; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin-receptor blocker; CCB: Calcium channel blocker; MINOCA: Myocardial infarction with nonobstructive coronary arteries; MACE: Major adverse cardiovascular event; HR: Hazard ratio; CI: Confidence interval; N/A: Not applicable;