[MINOCA-myocardial infarction with non-obstructive coronary arteries].

Area of Science:

• Cardiology
• Diagnostic Imaging
• Pathophysiology

Background:

• Increasing recognition of myocardial infarction (MI) cases lacking obstructive coronary artery disease (<50% diameter stenosis).
• Definition of myocardial infarction with non-obstructive coronary arteries (MINOCA) as a distinct clinical entity.
• MINOCA prevalence estimated at 6-9% of MI patients, with higher incidence in women and NSTEMI presentations.

Purpose of the Study:

• To outline the diagnostic approach for MINOCA.
• To identify potential underlying causes of MINOCA.
• To emphasize the importance of accurate diagnosis for treatment and prognosis.

Main Methods:

• MINOCA diagnosis requires exclusion of obstructive coronary artery disease.
• Invasive techniques like intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are utilized.
• Non-invasive cardiac magnetic resonance imaging (CMRI) plays a key role in diagnosis.

Main Results:

• MINOCA necessitates further work-up to identify specific etiologies.
• Potential causes include plaque rupture/erosion, thrombosis, dissection, vasospasm, or microvascular dysfunction.
• Non-coronary causes like myocarditis or tako-tsubo cardiomyopathy must be ruled out via CMRI.

Conclusions:

• The underlying cause of MINOCA dictates patient treatment strategies.
• Accurate diagnosis is essential for determining the appropriate prognosis.
• Further investigation beyond initial MI diagnosis is critical for MINOCA patients.