{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T09:28:57Z","timestamp":1772702937100,"version":"3.50.1"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T00:00:00Z","timestamp":1627862400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23HL150315"],"award-info":[{"award-number":["K23HL150315"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Optimal medical therapy after myocardial infarction with nonobstructive coronary arteries (MINOCA; &lt;50% stenosis) is uncertain. We evaluated variability in discharge prescription of angiotensin-converting enzyme inhibitors \/ angiotensin receptor blockers (ACEI\/ARB) and beta-blockers (BB) to MINOCA patients between hospitals to assess physician equipoise about secondary prevention.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients with MINOCA between 2007\u20132014 were identified in the NCDR Chest Pain\u2013MI Registry. Those with prior revascularization or missing demographic, angiographic, or medication data were excluded. Analysis was limited to high-volume hospitals with \u226520 MINOCA total discharges. Discharge prescriptions for ACEI\/ARB and BB after MINOCA were analyzed for each hospital. Clinical data on left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and diabetes mellitus status were extracted to identify other indications for ACEI\/ARB or BB.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Clinical data were available for 17,849 MINOCA patients, of whom 8,752 (49%) had LVEF &lt;40%, GFR \u226460 mL\/min, and\/or diabetes. 5,913 patients without one of these indications for ACEI\/ARB or BB were discharged from 156 high-volume hospitals. At discharge, ACEI\/ARB was prescribed to between 16.0% and 88.8% of MINOCA patients (median 45.6%, IQR 38.0%-56.5%) and BB to between 28.0% and 97.5% (median 74.1%, IQR 64.7%-80.0%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>There is marked variability between hospitals in the proportions of patients receiving ACEI\/ARB and BB after hospitalization for MINOCA, suggesting clinical equipoise about the routine use of these agents. Randomized clinical trials are necessary to establish the benefit of ACEI\/ARB and BB to improve outcomes after MINOCA.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0255462","type":"journal-article","created":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T17:26:33Z","timestamp":1627925193000},"page":"e0255462","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Variability of discharge medical therapy for secondary prevention among patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) in the United States"],"prefix":"10.1371","volume":"16","author":[{"given":"Nathaniel R.","family":"Smilowitz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Dubner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne S.","family":"Hellkamp","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3063-5651","authenticated-orcid":true,"given":"Robert J.","family":"Widmer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-0655","authenticated-orcid":true,"given":"Harmony R.","family":"Reynolds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,8,2]]},"reference":[{"key":"pone.0255462.ref001","first-page":"e891","article-title":"Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association","volume":"139","author":"JE Tamis-Holland","year":"2019","journal-title":"Circulation"},{"key":"pone.0255462.ref002","doi-asserted-by":"crossref","first-page":"e003443","DOI":"10.1161\/CIRCOUTCOMES.116.003443","article-title":"Mortality of Myocardial Infarction by Sex, Age, and Obstructive Coronary Artery Disease Status in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines).","volume":"10","author":"NR Smilowitz","year":"2017","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"pone.0255462.ref003","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth Universal Definition of Myocardial Infarction (2018)","volume":"138","author":"K Thygesen","year":"2018","journal-title":"Circulation"},{"key":"pone.0255462.ref004","first-page":"143","article-title":"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries","volume":"38","author":"S Agewall","year":"2017","journal-title":"Eur Heart J"},{"key":"pone.0255462.ref005","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1161\/CIRCULATIONAHA.116.026336","article-title":"Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease","volume":"135","author":"B Lindahl","year":"2017","journal-title":"Circulation"},{"key":"pone.0255462.ref006","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12933-021-01222-9","article-title":"Hyperglycemia, inflammatory response and infarct size in obstructive acute myocardial infarction and MINOCA","volume":"20","author":"P Paolisso","year":"2021","journal-title":"Cardiovascular diabetology"},{"key":"pone.0255462.ref007","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1161\/CIRCOUTCOMES.108.847145","article-title":"A call to ACTION (acute coronary treatment and intervention outcomes network): a national effort to promote timely clinical feedback and support continuous quality improvement for acute myocardial infarction","volume":"2","author":"ED Peterson","year":"2009","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"pone.0255462.ref008","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1161\/CIRCOUTCOMES.109.906214","article-title":"Utilization of secondary prevention therapies in patients with nonobstructive coronary artery disease identified during cardiac catheterization: insights from the National Cardiovascular Data Registry Cath-PCI Registry","volume":"3","author":"TM Maddox","year":"2010","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"pone.0255462.ref009","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.3389\/fphar.2019.01606","article-title":"Secondary Prevention Medical Therapy and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Artery Disease","volume":"10","author":"P Paolisso","year":"2019","journal-title":"Front Pharmacol"},{"key":"pone.0255462.ref010","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1056\/NEJMoa1406761","article-title":"Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy","volume":"373","author":"C Templin","year":"2015","journal-title":"N Engl J Med"},{"key":"pone.0255462.ref011","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1016\/j.ahj.2011.07.011","article-title":"In women with symptoms of cardiac ischemia, nonobstructive coronary arteries, and microvascular dysfunction, angiotensin-converting enzyme inhibition is associated with improved microvascular function: A double-blind randomized study from the National Heart, Lung and Blood Institute Women\u2019s Ischemia Syndrome Evaluation (WISE).","volume":"162","author":"DF Pauly","year":"2011","journal-title":"Am Heart J"},{"key":"pone.0255462.ref012","doi-asserted-by":"crossref","first-page":"2710","DOI":"10.1016\/j.jacc.2017.03.578","article-title":"beta-Blockers and Mortality After Acute Myocardial Infarction in Patients Without Heart Failure or Ventricular Dysfunction","volume":"69","author":"TB Dondo","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"pone.0255462.ref013","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ijcard.2020.11.040","article-title":"Pharmacological therapy for the prevention of cardiovascular events in patients with myocardial infarction with non-obstructed coronary arteries (MINOCA): Insights from a multicentre national registry","volume":"327","author":"G Ciliberti","year":"2021","journal-title":"International journal of cardiology"},{"key":"pone.0255462.ref014","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ahj.2020.10.059","article-title":"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","volume":"231","author":"AM Nordenskjold","year":"2021","journal-title":"Am Heart J"},{"key":"pone.0255462.ref015","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/bmj.324.7329.71","article-title":"Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients","volume":"324","author":"C Antithrombotic Trialists","year":"2002","journal-title":"BMJ"},{"key":"pone.0255462.ref016","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1056\/NEJM199610033351401","article-title":"The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators","volume":"335","author":"FM Sacks","year":"1996","journal-title":"N Engl J Med"},{"key":"pone.0255462.ref017","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1161\/CIRCULATIONAHA.114.011201","article-title":"Systematic review of patients presenting with suspected myocardial infarction and nonobstructive coronary arteries","volume":"131","author":"S Pasupathy","year":"2015","journal-title":"Circulation"},{"key":"pone.0255462.ref018","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1161\/CIRCULATIONAHA.120.052008","article-title":"Coronary Optical Coherence Tomography and Cardiac Magnetic Resonance Imaging to Determine Underlying Causes of Myocardial Infarction With Nonobstructive Coronary Arteries in Women","volume":"143","author":"HR Reynolds","year":"2021","journal-title":"Circulation"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255462","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T17:26:46Z","timestamp":1627925206000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0255462"}},"subtitle":[],"editor":[{"given":"Carmine","family":"Pizzi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,8,2]]},"references-count":18,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0255462","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,2]]}}}