Page 44 - BH-3-3

Brain & Heart A review on MINOCA

Kang et al. conducted an analysis of 9138 patients with 8.3. Coronary embolism/thrombosis
36
MINOCA enrolled in SWEDEHEART registry and found It is debatable whether long-term anticoagulants or
a positive relationship between treatment with statins, antiplatelet therapy should be given to patients with
angiotensin-converting-enzyme inhibitors/angiotensin MINOCA due to coronary thrombosis or embolism.
II receptor blockers (ACE inhibitors/ARBs), β-blockers, Further, in-depth research is needed for this.
and dual antiplatelet therapy and the composite of all- Antithrombotic and occasional antiplatelet medications
cause mortality or hospitalization for reinfarction, are typically used to treat coronary thrombosis. Adjunctive
heart failure, or stroke in these patients. Following medications such as rituximab and prednisone are used
an average 4.1-year follow-up period, the use of ACE in conjunction with plasma infusions to allow for plasma
inhibitors/ARBs, statins, and β-blockers was linked to a exchange, as is the case with TTP.
significantly lower event rate. While we await the findings
of randomized, controlled trials before making any firm 8.4. SCAD
recommendations, the results of this retrospective study At present, there is not a single randomized prospective
favor the use of cardioprotective treatments in patients trial that addresses how best to treat SCAD throughout
with MINOCA. its acute or post-acute phases. Percutaneous coronary
8. Cause-specific management intervention and stenting are generally avoided in the acute
phase unless the patient is hemodynamically unstable or
8.1. Plaque disruption presents with ST-elevation MI with complete coronary
artery occlusion. This recommendation is supported by
45
Due to similar pathophysiology to AMI-CAD, aspirin
should be the cornerstone initial therapy for patients the findings that most coronary segments with SCAD heal
on their own and that revascularization is linked to a higher
with MINOCA due to plaque disruption. These patients risk of sequelae, including the spread of the dissection and
also require cardioprotective agents according to AMI intramural hematoma. There is also a lack of documented
guidelines. Plaque erosion and rupture should be treated medical treatment for SCAD. Aspirin and beta-blockers
37
identically because the American Heart Association’s are often used in the management of this patient cohort.
current guidelines do not distinguish between the two Based on observational data, patients with SCAD who
conditions. Even though the SWEDEHEART registry’s were prescribed β-blockers had a decreased risk. It is
38
46
observational cohort study refuted the benefit of dual still debatable whether anticoagulants, P2Y12 inhibitors,
antiplatelet therapy, this study was conducted on all and aspirin should be used in the immediate phase of
MINOCA patients without distinguishing between SCAD management. Theoretically, such agents enhance
patients with plaque disruption and those with other the likelihood of bleeding and the spread of hematoma.
causes. Extrapolation from AMI clinical studies has However, some studies suggest that intimal tears may be
39
shown increased benefit from adding a P2Y12 receptor prothrombotic and that it may be appropriate to take a
inhibitor to aspirin, suggesting that a second antiplatelet moderately powerful P2Y12 inhibitor, such as clopidogrel.
47
drug is feasible. 40 The administration of additional cardioprotective drugs
8.2. Coronary vasospasm should be tailored based on the patient’s unique risk
profile. While long-term research is needed to confirm,
Since calcium channel blockers act through calcium some specialists advise patients to refrain from intense
transduction, they are the mainstay of treatment for patients exercise or plan for future pregnancies. 48,49
with coronary spasm. This is because they have been shown
to suppress angina symptoms in patients with vasospastic 8.5. Myocardial bridging
angina, and their absence is an independent predictor Beta-blockers are regarded as the first-line therapy for MI
41
of cardiovascular events in patients with vasospastic because of their negative chronotropic and inotropic effects,
angina. Two calcium channel blockers that target distinct as well as the fact that they lower heart rate and lengthen
42
receptors have been proven to reduce symptoms in people diastolic filling time, allowing for decompression of the
with refractory vasospastic angina. The advantage of intramyocardial segment. Given its extremely selective
43
50
long-acting nitrate is less evident, whereas short-acting beta 1 blockage and potential advantages for improving
sublingual nitrate is beneficial in immediately relieving endothelial function through beta 3 receptor stimulation,
44
coronary vasospasm. A phosphodiesterase 3 inhibitor, nebivolol may be the best option. However, by covering
51
cilostazol, and a potassium channel opener, nicorandil, up α-adrenoreceptors in the coronary circulation, beta-
have also been demonstrated to be beneficial in reducing blockers may exacerbate epicardial or microvascular
coronary spasm. spasm, promoting coronary vasoconstriction. Thus, as

Volume 3 Issue 3 (2025) 5 doi: 10.36922/bh.5811