Effect of dual antiplatelet therapy on prognosis of patients with myocardial infarction with nonobstructive coronary artery disease

BACKGROUND: The diverse pathogenic mechanisms of myocardial infarction with nonobstructive coronary artery disease (MINOCA) result in therapeutic difficulties. The purpose of this meta-analysis was to assess the impact of dual antiplatelet therapy (DAPT) on prognosis of patients with MINOCA. METHODS: Relevant studies published prior to May 2025 were identified through a search of the PubMed, Embase and Web of Science databases. We evaluated the data using hazard ratios (HRs) and 95% confidence interval (CI). Heterogeneity among studies was assessed by I2 and Cochran's Q test. To identify the sources of heterogeneity, subgroup analysis was conducted according to the predefined criteria. RESULTS: Six studies enrolling 13,027 patients with MINOCA were pooled in the meta-analysis. After 48 months of follow-up, DAPT showed no significant association with a reduced risk of major adverse cardiovascular events (HR = 1.00; 95% CI, 0.71-1.41; P = .985). Aggregate data from 4 studies indicated that DAPT was associated with a significant reduction of all-cause death (HR = 0.76; 95% CI, 0.60-0.96; P = .021). However, results from 3 studies regarding myocardial infarction were not statistically significant (HR = 1.03; 95% CI, 0.72-1.45; P = .885). CONCLUSION: Our findings suggest that while DAPT offers a survival benefit for MINOCA patients, it does not reduce the risk of major adverse cardiovascular events and myocardial infarction. Further large randomized controlled trials are required to evaluate individual treatment based on the different etiologies of MINOCA.