NSTEMI with Nonobstructive CAD (50% focal mid-LCx) — Medical Therapy

No revascularization indicated → standard post-ACS GDMT, since a discrete atherosclerotic plaque (not normal coronaries) was identified

Class	Drug (Generic / Brand)	Dose	Key consideration
Antiplatelet	Aspirin (Aspirin) + Clopidogrel (Plavix)	81 mg PO OD, indefinite 75 mg PO OD × 12 mo	DAPT duration data are extrapolated mainly from PCI cohorts (2025 ACC/AHA ACS Guideline); reassess bleeding risk before continuing past 12 months.
Statin	Atorvastatin (Lipitor)	40–80 mg PO OD	High-intensity statin recommended for all ACS regardless of obstructive severity; target LDL-C <70 mg/dL, add ezetimibe if not at goal.
ACEI/ARB	Ramipril (Tritace) or Perindopril (Coversyl)	2.5–10 mg OD / 4–8 mg OD	Registry data (SWEDEHEART) show mortality/MACE benefit even without obstructive disease; prioritize if LVEF reduced, diabetic, hypertensive, or CKD.
Beta-blocker	Bisoprolol (Concor) or Metoprolol succinate (Betaloc ZOK)	2.5–10 mg OD / 25–100 mg OD	Strong indication if LVEF ≤40%; benefit less certain with preserved EF but still commonly continued per observational data.

Why standard GDMT, not "pure MINOCA" protocol: AHA's 2019 MINOCA Scientific Statement reserves statin/antiplatelet specifically for cases with confirmed plaque disruption. This patient has a visualized focal 50% mid-LCx lesion (atherosclerotic, just non-flow-limiting) — not angiographically normal coronaries — so standard type-1-MI secondary prevention GDMT applies rather than the more restrictive/individualized MINOCA pathway.

No Thai CPG addresses nonobstructive/non-flow-limiting NSTEMI specifically. Sources: 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS Guideline (GDMT, lipid targets); AHA 2019 Scientific Statement on MINOCA (Circulation 2019;139:e891–e908); SWEDEHEART registry data on secondary prevention in non-obstructive MI.