Introduction:
Myocardial infarction with non-obstructive coronary arteries (
MINOCA) occurs in ~10% of all patients with acute
myocardial infarction (AMI), with an over-representation amongst women. Remarkably, it is estimated that as many as 1 in 4 patients with
MINOCA experience ongoing angina at 12 months despite having no flow-restricting
stenoses in their epicardial arteries. This manuscript presents the rationale behind Randomized Evaluation of Beta Blocker and
Angiotensin-converting enzyme inhibitors/
Angiotensin Receptor Blocker Treatment (ACEI/ARB) for Post
Infarct Angina in
MINOCA patients-The
MINOCA BAT post
infarct angina sub study. Methods: This trial is a registry-based, randomized, parallel, open-label, multicenter trial with 2 × 2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce post
infarct angina in patients discharged after
MINOCA without clinical signs of
heart failure and with left ventricular ejection fraction ≥40%. A total of 664 patients will be randomized into four groups; (i) ACEI/ARB with beta blocker, (ii) beta blocker only, (iii) ACEI/ARB only, or (iv) neither ACEI/ARB nor beta blocker and followed for 12 months. Results: The trial is currently recruiting in Australia and Sweden. Fifty six patients have been recruited thus far. Both sexes were equally distributed (52% women and 48% men) and the mean age was 56.3 ± 9.9 years. Conclusions: It remains unclear whether conventional secondary preventive
therapies are beneficial to
MINOCA patients in regard to post
infarct angina. Existing registry-based literature suggest
cardioprotective agents are less likely to be used in
MINOCA patients. Thus, results from this trial will provide insights for future treatment strategies and guidelines specific to
MINOCA patients.