Randomized evaluation of beta blocker and ACE-inhibitor/angiotensin receptor blocker treatment in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA-BAT): Rationale and design: MINOCA-BAT: Rationale and design

Research output: Contribution to journalArticle

Abstract

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6–8% of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial ‘Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients’ (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. Methods: MINOCA-BAT 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 the composite endpoint of death of any cause, readmission because of AMI, ischemic stroke or heart failure in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 3500 patients will be randomized into four groups; e.g. ACEI/ARB and beta blocker, beta blocker only, ACEI/ARB only and neither ACEI/ARB nor beta blocker, and followed for a mean of 4 years. While patients with MINOCA have an increased risk of serious cardiovascular events and death, whether conventional secondary preventive therapies are beneficial has not been assessed in randomized trials. There is a limited basis for guideline recommendations in MINOCA. Furthermore, studies of routine clinical practice suggest that use of secondary prevention therapies in MINOCA varies considerably. Thus results from this trial may influence future treatment strategies and guidelines specific to MINOCA patients.

Details

Authors
  • Anna M. Nordenskjöld
  • Stefan Agewall
  • Dan Atar
  • Tomasz Baron
  • John Beltrame
  • Olle Bergström
  • David Erlinge
  • Chris P. Gale
  • Javier López-Pais
  • Tomas Jernberg
  • Pelle Johansson
  • Annica Ravn-Fisher
  • Harmony R. Reynolds
  • Jithendra B. Somaratne
  • Per Tornvall
  • Bertil Lindahl
Organisations
External organisations
  • Örebro University
  • Oslo university hospital
  • Uppsala University Hospital
  • University of Adelaide
  • Complejo Hospitalario Universitario de Santiago
  • Danderyd Hospital
  • Sahlgrenska Academy
  • New York University
  • Auckland City Hospital
  • Karolinska Institutet
  • Region Kronoberg
  • University of Leeds
  • Hjärt-Lungfonden
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)96-104
Number of pages9
JournalAmerican Heart Journal
Volume231
Publication statusPublished - 2021 Jan
Publication categoryResearch
Peer-reviewedYes