Optimal Management for Post-MI Patient with Non-Obstructive CAD

Current Medication Assessment

• The American College of Cardiology recommends continuation of dual antiplatelet therapy with Brilinta 60mg twice daily for post-MI patients 2, 4
• The American College of Cardiology suggests that Amlodipine 5mg daily is reasonable for blood pressure control and symptom management in post-MI patients 1, 5

Critical Medication Optimization Required

• The American Heart Association recommends increasing Atorvastatin from 40mg to 80mg daily immediately for high-intensity statin therapy in post-MI patients 3, 6
• All post-MI patients require high-intensity statin therapy regardless of angiographic findings, according to the American College of Cardiology 3, 6

Antiplatelet Therapy Management

• The American College of Cardiology recommends continuing Aspirin 75-100mg daily indefinitely plus Clopidogrel/Ticagrelor for at least 12 months post-MI 1, 2, 6
• Aspirin should be continued indefinitely at 75-162mg daily, according to the American College of Cardiology 1, 2

Beta-Blocker Therapy

• The American College of Cardiology recommends ensuring patient is on evidence-based beta-blocker therapy if not already prescribed, with a target heart rate of 50-60 bpm at rest 1, 5, 8
• Beta-blockers should be started and continued indefinitely in all post-MI patients, according to the American College of Cardiology 1, 8

Management of Non-Obstructive CAD Findings

• The American College of Cardiology suggests that intraluminal irregularities in the circumflex and RCA represent diffuse coronary atherosclerosis requiring intensive secondary prevention 4, 6
• No revascularization is indicated for 30% LAD stenosis or intraluminal irregularities, according to the American College of Cardiology 4, 6

Comprehensive Risk Factor Modification

• The American Heart Association recommends targeting blood pressure <130/80 mmHg for post-MI patients 1, 3
• The American College of Cardiology suggests enrolling patient in cardiac rehabilitation program immediately for exercise-based cardiac rehabilitation 6, 7

Additional Preventive Measures

• The American College of Cardiology recommends administering annual influenza vaccination to reduce mortality risk in cardiovascular disease patients 1, 8, 6, 7

Monitoring and Follow-Up

• The American College of Cardiology suggests reviewing patient response to statin intensification and any valsartan dose adjustment within 2-4 weeks 6, 7
• Regular follow-up every 3-6 months is recommended for medication adherence and symptom assessment, according to the American College of Cardiology 6, 7

Critical Pitfalls to Avoid

• The American College of Cardiology recommends not pursuing repeat coronary angiography or revascularization for non-obstructive disease 4, 6, 7
• Premature discontinuation of DAPT increases risk of stent thrombosis and recurrent MI, according to the American College of Cardiology 2, 4, 6